1
|
Ellouze M, Bouchard D, Pham M, Noly PE, Perrault LP, Cartier R, Carrier M. Coronary endarterectomy in patients with diffuse coronary artery disease: assessment of graft patency with computed tomography angiography. Can J Surg 2022; 65:E635-E641. [PMID: 36130806 PMCID: PMC9503562 DOI: 10.1503/cjs.011121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background: With a growing population of patients with advanced coronary artery disease (CAD), many of whom have undergone prior percutaneous coronary interventions, coronary endarterectomy (CE) allows for the extension of revascularization in patients with otherwise limited options. Whether adjunctive CE associated with standard surgery, combined with contemporary antiplatelet therapy, improves outcomes remains largely unknown. Methods: We studied 147 consecutive patients who underwent 154 adjunctive CE procedures for advanced CAD between January 2015 and January 2018. We used computed tomography angiography (CTA) in a subgroup of 32 consecutive patients who underwent CE during coronary artery bypass grafting after June 2016 to assess graft and coronary patency. Results: Patients (mean age 67 ± SD 10 yr) underwent CE of the right (102 patients), the left anterior descending (LAD, 22 patients) and the circumflex (17 patients) coronary arteries. Seven patients (5%) experienced a procedural myocardial infarction and there were no perioperative deaths. Among the 32 patients who underwent CTA 3 months after surgery, the mean patency of the endarterectomized coronary arteries and bypass grafts was 90% and 88%, respectively. All 6 arterial grafts on the LAD artery were patent. The mean survival rate and the mean rate of freedom from major adverse cardiovascular events was 95% ± 2% and 95% ± 6%, respectively. The patency rate was 100 % for patients evaluated at 3-year follow up. Conclusion: Coronary endarterectomy offers a surgical option for patients with diffuse CAD who may be unsuitable for coronary bypass alone. Grafts and endarterectomized coronary artery patency remain adequate and explain the excellent patient survival and the freedom rate from major adverse cardiovascular events.
Collapse
Affiliation(s)
- Mariam Ellouze
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Denis Bouchard
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Magali Pham
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Pierre Emmanuel Noly
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Louis P Perrault
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Raymond Cartier
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Michel Carrier
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que.
| |
Collapse
|