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Li H, Gu C, Li B. Endarterectomy may be an effective additional treatment for three diffuse coronary artery disease complicated with diabetes. Perfusion 2024:2676591241237640. [PMID: 38446911 DOI: 10.1177/02676591241237640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE In order to evaluate the clinical efficacy of coronary endarterectomy (CE) and coronary artery bypass grafting (CABG) in patients with diabetes complicated with three diffuse coronary artery stenosis. METHODS A retrospective analysis was conducted on 460 patients with diabetes mellitus and diffuse three-vessel coronary artery disease who underwent CABG in our department from September 2015 to December 2021. The patients were divided into two groups according to whether they underwent CE: the simple CABG group (group A, n = 254) and the CABG combined CE group (group B, n = 206). The perioperative outcomes, recurrent angina pectoris during 1-year follow-up, and the patency rate of the grafted vessel in coronary CT angiography were compared between the two groups. RESULTS There was no significant difference in the 30 days mortality rate between the two groups (2.3% vs 2.4%, p < 0.05). Group A had a shorter operation time [(3.55 ± 0.59) h versus (4.35 ± 0.65) h], less bypass grafts [(2.72 ± 0.83) versus (3.65 ± 0.72) vessels/case], a lower incidence of perioperative myocardial infarction (7.1% vs 12.6%), and a lower number of patent graft vessels at 1-year follow-up [(2.15 ± 0.42) versus (2.88 ± 0.68) vessels/case] compared with group B (all p < 0.05). Group A had a higher incidence of recurrent angina during follow-up (14.49% vs 6.47%) (p < 0.05). Although there was no significant difference in the incidence of MACCE events between the two groups, the probability of revascularization was higher in group A. CONCLUSION Compared with single CABG, combined CE in patients with diabetes mellitus and diffuse three-vessel coronary artery disease can achieve more complete revascularization, reduce the recurrence of angina pectoris and the needing of postoperative revascularization, but the incidence of perioperative myocardial infarction is higher.
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Affiliation(s)
- Haiming Li
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
| | - Bo Li
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
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Chen L, Gao MX, Du X, Wang C, Yu WY, Liu HL, Ding XH, Wang BL, Zhang K, Xu D, Han Z, Xie BD, Dong R, Yu Y. Early tirofiban versus heparin for bridging dual antiplatelet therapy in patients undergoing coronary endarterectomy combined with coronary artery bypass grafting: a multicenter randomized controlled trial protocol (the THACE-CABG trial). Trials 2024; 25:52. [PMID: 38225640 PMCID: PMC10789027 DOI: 10.1186/s13063-023-07737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/17/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND For complete revascularization, patients with diffuse coronary artery disease should have a coronary endarterectomy and a coronary artery bypass graft (CE-CABG). Sadly, CE can lead to a lack of endothelium, which raises the risk of thrombotic events. Even though daily dual antiplatelet therapies (DAPT) have been shown to reduce thrombotic events, the risk of perioperative thrombotic events is high during the high-risk period after CE-CABG, and there is no consistent protocol to bridge DAPT. This trial aims to compare safety and efficacy between tirofiban and heparin as DAPT bridging strategies after CE-CABG. METHODS In phase I, 266 patients undergoing CE-CABG will be randomly assigned to tirofiban and heparin treatment groups to compare the two treatments in terms of the primary safety endpoint, chest tube drainage in the first 24 h. If the phase I trial shows tirofiban non-inferiority, phase II will commence, in which an additional 464 patients will be randomly assigned. All 730 patients will be studied to compare major cardiovascular and cerebrovascular events (MACCEs) between the groups in the first 30 days after surgery. DISCUSSION Given the possible benefits of tirofiban administration after CE-CABG, this trial has the potential to advance the field of adult coronary heart surgery. TRIAL REGISTRATION chictr.org.cn, ChiCTR2200055697. Registered 6 January 2022. https://www.chictr.org.cn/com/25/showproj.aspx?proj=149451 . Current version: 20,220,620.
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Affiliation(s)
- Liang Chen
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
- Department of Cardiovascular Surgery, Shanghai Deltahealth Hospital, Shanghai, China
| | - Ming-Xin Gao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Heart Health Research Center, Beijing, China
| | - Chi Wang
- Heart Health Research Center, Beijing, China
| | - Wen-Yuan Yu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Hong-Li Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Xiao-Hang Ding
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Bo-Lin Wang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Kui Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Dong Xu
- Department of Cardiovascular Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Han
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Bao-Dong Xie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin, China
| | - Ran Dong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China.
| | - Yang Yu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China.
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Gao M, Wen W, Gu C, Zhang X, Yu Y, Li H. Coronary plaque burden predicts perioperative cardiovascular events after coronary endarterectomy. Front Cardiovasc Med 2023; 10:1175287. [PMID: 37363096 PMCID: PMC10289079 DOI: 10.3389/fcvm.2023.1175287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background and aims The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative cardiovascular events after off-pump CABG + CE. Methods This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG + CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE, was calculated. The primary endpoint was perioperative myocardial infraction (PMI). Results Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4 ± 1.5 vs. 1.6 ± 0.9, p = .001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p = .005). Patients with plaque length-max ≥1.15 had a > 5-fold increase in PMI after adjusting for confounding factors (odds ratio = 5.89; p = .002). Furthermore, interleukin-6 (Beta = .32: p = .028), CD68 (Beta = .34; p = .045), and osteopontin (Beta = .43; p = .008) were significantly correlated with plaque length-max. Conclusions Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG + CE, which might be associated with systemic and plaque inflammation state.
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Affiliation(s)
- Mingxin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wanwan Wen
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XiaoLi Zhang
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haiyang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Robu M, Marian DR, Lazăr E, Radu R, Boroș C, Sibișan A, Voica C, Broască M, Gheorghiță D, Moldovan H, Iliescu VA. Open Coronary Endarterectomy of Left Anterior Descending Artery—Case Report and Review of Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9030083. [PMID: 35323631 PMCID: PMC8954667 DOI: 10.3390/jcdd9030083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Coronary endarterectomy (CE) emerged as a necessity to achieve complete surgical myocardial revascularization in patients with diffusely diseased coronary arteries and it also serves as aid to coronary bypass grafting (CABG). The safety and postoperative prognosis of this procedure are still matters of debate. There are no clear preoperative indications, a standard technique has not yet been established as gold standard and the postoperative management differs depending on each institution. CE of the left anterior descending artery (LAD) is technically challenging and potentially hazardous with high risk of postoperative myocardial infarction. In this article, we describe the open technique for CE of the LAD with its specific details, which we believe could be the safest and the best reproductible option. To better understand the profile of a patient requiring such a procedure we present the case of a 73-years old male with diffused coronary artery disease (CAD) and a short review of literature.
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Affiliation(s)
- Mircea Robu
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Diana Romina Marian
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Ecaterina Lazăr
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Răzvan Radu
- Cardiology Department, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Cristian Boroș
- Anesthesia and Intensive Care Department, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Andra Sibișan
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Cristian Voica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Marian Broască
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Horațiu Moldovan
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence:
| | - Vlad Anton Iliescu
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Kelly JJ, Han JJ, Desai ND, Iyengar A, Acker AM, Grau-Sepulveda M, Zwischenberger BA, Jawitz OK, Hargrove WC, Szeto WY, Williams ML. Coronary Endarterectomy: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2022; 114:667-674. [DOI: 10.1016/j.athoracsur.2022.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
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Chow SC, Ho JY, Kwok MW, Fujikawa T, Lim K, Wan S, Wong RH. Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival. Asian Cardiovasc Thorac Ann 2021; 30:147-155. [PMID: 33823658 DOI: 10.1177/02184923211006851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. METHODS Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan-Meier and logistic regression analysis. RESULTS The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). CONCLUSIONS Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.
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Affiliation(s)
- Simon Cy Chow
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Jacky Yk Ho
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Micky Wt Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Kevin Lim
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Randolph Hl Wong
- Division of Cardiothoracic Surgery, Department of Surgery, 13621Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
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El-Gamel A, Chan B. Full Metal Jacket Endarterectomy of Left Anterior Descending Coronary Artery is Safe With Good Midterm Outcomes. Heart Lung Circ 2020; 30:605-611. [PMID: 32952038 DOI: 10.1016/j.hlc.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/16/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multiple overlapping stents (Full metal jacket, FMJ) from percutaneous coronary artery intervention (PCI) renders coronary artery bypass modus operandi unmanageable. We report our surgical revascularisation in patients with failed full metal jacket of left anterior descending coronary artery (FMJ-LAD). METHODS We reviewed 22 patients who presented with FMJ-LAD From 2006 to 2019. Extensive endarterectomy involving almost the whole length of the left anterior descending (LAD) was performed, the arteriotomy patched up with a saphenous vein. All reconstructed LADs were grafted with the left internal mammary artery. We compared the group to propensity-matched patients with single proximal LAD lesions requiring coronary artery bypass graft (CABG). RESULTS The mean age was 54±3.5 years. Twenty-one (21) patients (95%) were in angina class III or IV despite maximum medical therapy. Fourteen (14) patients (63.6%) presented with MI within 1 month. All patients had a preoperative positive test for ischaemia. Cross-clamp and bypass times were significantly shorter (25.5±7 mins and 65±5 mins, versus 52±3 mins and 77.2±4 mins) in the CABG group compared to FMJ-LAD group, the mean hospital stay of 6±1.5 days was not different between the groups. Postoperative electrocardiograms showed non-specific changes in 75% (n=16) with no enzyme rise. Early postoperative angiography was performed in 10 patients because of the new electrocardiograph (ECG) changes; all FMJ-LAD patients had an angiogram at 1 year, two late angiograms (2 and 3 years postoperatively), and one computed tomography (CT)-angiogram for readmission with angina. All patients in the FMJ-LAD group had 12 months follow-up angiogram or cardiac CT scan. All the endarterectomies' LADs were patent. There was no mortality within the 30 days. Patients' follow-up time was between 1-13 years. CONCLUSIONS Open stent endarterectomy is a valuable alternative option for patients with "full metal jacket" diseased LAD that is not graftable using standard techniques with acceptable midterm results.
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Affiliation(s)
- Adam El-Gamel
- Department of Cardiothoracic Surgery, Waikato Hospital, Waikato, New Zealand; Department of Surgery, Auckland University, Auckland, New Zealand.
| | - Brian Chan
- Department of Cardiothoracic Anesthesia, Waikato Hospital, Waikato, New Zealand
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Kyuchukov D, Zheleva-Kyuchukova I, Nachev G. Antithrombotic regimens in patients after coronary artery bypass grafting and coronary endarterectomy. PHARMACIA 2020. [DOI: 10.3897/pharmacia.67.e52738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Coronary artery bypass grafting (CABG) remains the gold standard in the treatment of complex chronic forms of coronary heart disease (CHD). Coronary endarterectomy (CEAE) is a useful adjunctive technique to CABG in patients with diffuse coronary artery disease. In order to maintain the patency of the coronary arteries and graft conduits, various antithrombotic protocols have been introduced over the years, combining various antiplatelet and anticoagulant drugs, but still there is no consensus.
Aim: The aim of the study is to compare results between two antithrombotic regimens after CEAE. The first one is a combination of acenocoumarol combined with acetylsalicylic acid (ASA), the second regimen is a dual antiplatelet therapy (DAPT) of clopidogrel combined with ASA.
Material and methods: We retrospectively reviewed 56 consecutive patients (60 ± 8.2 years) undergoing isolated CABG in association with CEAE between January 2018 and December 2019. In the postoperative period, patients were divided into two groups according to the antithrombotic regimens described above. Twenty-four were in the ASA and acenocoumarol group (AA) and 32 were in the ASA and clopidogrel group (AC). Patients were followed up to 30 days after the operation and we access the mortality rate, new ECG changes, levels of myocardial fraction of creatinine phosphokinase (CPK-MB), left ventricular systolic function, pericardial or pleural effusions requiring drainage or revision for bleeding.
Results: Operative mortality was 3,6 %. No differences in the antithrombotic efficacy of the two regimens. A significantly higher level of hemorrhagic complications was observed in the ASA + acenocoumarol treatment group.
Conclusion: Dual antiplatelet therapy (DAPT) after CABG and coronary endarterectomy is an effective pharmacological regimen in regard to 30-day postoperative outcomes and is considerably safety in terms of bleeding complications.
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Shehada SE, Mourad F, Balaj I, El Gabry M, Wendt D, Thielmann M, Schlosser T, Jakob H. Long-Term Outcomes of Coronary Endarterectomy in Patients With Complete Imaging Follow-Up. Semin Thorac Cardiovasc Surg 2020; 32:730-737. [DOI: 10.1053/j.semtcvs.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 11/11/2022]
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Coronary endarterectomy: an old tool for patients currently operated on with coronary artery bypass grafting. Long-term results, risk factor analysis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 15:219-226. [PMID: 30647744 PMCID: PMC6329878 DOI: 10.5114/kitp.2018.80917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/29/2018] [Indexed: 11/17/2022]
Abstract
Aim Coronary endarterectomy (CE) may provide a useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffuse coronary artery disease. Nevertheless, the incidence of complications still remains high, long-term results remain unclear, and no risk factors for late mortality have been completely described yet. Material and methods We retrospectively reviewed 90 consecutive patients (67 ±8.2 years) undergoing isolated CABG in association with CE between 2006 and 2013. Mean follow-up was 75.1 ±36.2 months (median: 84 months) and it was 100% complete (6755/6755 patient-months). Results Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-year survival was 83.3 ±4.1%, freedom from cardiac death 92.7 ±2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2 ±10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (p = 0.018) and chronic obstructive pulmonary disease (p = 0.036). Ten-year freedom from cardiac death was better after CE on the left descending coronary artery (LAD) (93.2 ±3.3%) in comparison to CE not on the LAD (74.6 ±10.2%), although this difference did not reach statistical significance (p = 0.102). Conclusions Although the incidence of perioperative myocardial infarction continues to be not negligible, in the presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. Coronary endarterectomy on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which to focus attention due to the increased risk of late death.
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Minato N, Okada T, Kanemoto S, Zempo N. Segmental clamp and distal perfusion technique for reducing myocardial ischemia during coronary onlay grafting on a beating heart. Surg Today 2018; 48:566-570. [PMID: 29318373 DOI: 10.1007/s00595-017-1623-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
Abstract
We present a segmental clamp with distal perfusion technique to reduce myocardial ischemia during onlay grafting, on a beating heart. After a proximal coronary arteriotomy for 2-3 cm, the distal artery is perfused through a cannula, with femoral arterial blood (distal perfusion with external shunt). During proximal and distal coronary snare clamping with distal perfusion, onlay anastomosis is performed, from the heel toward the point of cannula insertion. We then move the proximal clamp to the onlay area and open the graft, to get early proximal coronary reperfusion. The arteriotomy is extended, and this procedure is repeated to achieve complete beating heart onlay anastomosis. We safely performed this procedure on the beating heart off-pump or on-pump in 95 patients with no perioperative myocardial infarction, no intraoperative hemodynamic deterioration, no 30-day mortality. This technique reduces regional myocardial ischemic and secures the safety for onlay grafting on the beating heart.
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Affiliation(s)
- Naoki Minato
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
| | - Takayuki Okada
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Shinya Kanemoto
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Nobuya Zempo
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
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Roberts WC, Berry AE. Frequency of Coronary Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting at a Single Tertiary Texas Hospital 2010 to 2016 With Morphologic Studies of the Operatively Excised Specimens. Am J Cardiol 2017; 120:2164-2169. [PMID: 29056229 DOI: 10.1016/j.amjcard.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/01/2022]
Abstract
This study examines the frequency of coronary endarterectomy (CE) procedures during coronary artery bypass grafting (CABG), and determines the quantity of plaque in the specimens. Of the 2,268 CABG operations performed from January 2010 to June 2016, 35 patients had CE during CABG. The specimens were incised into 5-mm cross sections, stained by the Movat method, and examined. The number of CEs performed ranged from 0.21% to 4.01%. A total of 140 cm of specimens were examined, and all 140 cm contained considerable quantities of atherosclerotic plaque and narrowed lumens. The quantity of plaque present was similar to or greater than that observed in previously studied patients with fatal coronary artery disease. The frequency of CE during CABG varies greatly in surgeons. The quantity of plaque is enormous, and the lumens are severely narrowed.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, The Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas.
| | - Anna E Berry
- Baylor Heart and Vascular Institute, The Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
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Ghatanatti R, Teli A. Coronary Endarterectomy: Recent Trends. J Clin Diagn Res 2017; 11:PE01-PE04. [PMID: 28969206 DOI: 10.7860/jcdr/2017/27036.10339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Coronary Endarterectomy (CE) assures complete revascularization of the myocardium in case of diffusely diseased vessels and prevents residual ischemia. Recently cardiac surgeons are performing increasing number of coronary endarterectomy and it has evolved as an important adjuvant procedure in Coronary Artery Bypass Grafting (CABG). There are controversies regarding the efficiency of CE. CE is criticised for its higher rates of morbidity and mortality. At present the available evidence supports CE in Off Pump Coronary Artery Bypass surgery (OPCAB) and along with valvular procedures. Graft patency is better with open technique. Postoperative anticoagulation regimen though not uniform, the overall outcome remains the same. Therefore, it is important to focus on the current results to accept CE as a routine procedure like CABG.
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Affiliation(s)
- Ravi Ghatanatti
- Consultant Cardiac Surgeon, Department of Cardiothoracic and Vascular Surgery, KLE's Dr Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | - Anita Teli
- Assistant Professor, Department of Physiology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Katselis C, Samanidis G, Papasotiriou A, Karatasakis G, Nenekidis I, Demerouti E, Antoniou T, Perreas K. Outcomes after a left anterior descending artery endarterectomy in advanced coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:332-337. [PMID: 28283374 DOI: 10.1016/j.carrev.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/05/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Coronary endarterectomy albeit infrequently utilized remains a pivotal treatment modality for advanced atherosclerotic heart disease. Benefits of coronary endarterectomy are explored in terms of better mid-term survival, freedom of major adverse cardiac and cerebrovascular events and improved left ventricular ejection fraction. METHODS 50 patients with coronary artery disease including extensive diffuse LAD disease underwent a left anterior descending artery endarterectomy with coronary by-pass grafting and left internal mammary artery as conduit between 2006 and 2014. Prospective evaluation was performed on an outpatient basis with physical examination, echo recordings of ejection fraction and LAD flow reserve for 24 up to 60months. RESULTS Study group was constituted by a male to female ratio 4:1 and mean age 62.4years old. Pre-operative characteristics included patients with age<60years old and gensini score>60 in 42.1% while patients with age>60years old had gensini score (21-60) in 63.4%. Furthermore, males were affected more severely by atherosclerosis than females. Postoperative anterior wall contractility of left ventricle was improved (56% pre-op vs. 66% post-op) and hypokinesis reduced (34% pre-op vs. 24% post-op). No deaths were recorded for a mean follow-up of 48months. Also, MACCE were recorded in 8% patients. Post-operative LAD flow reserve was normal in 66% and reduced in 33% of cases. Finally, gensini score preoperatively affects mid-term flow reserve postoperatively (p<0.05). CONCLUSION Coronary endarterectomy presents a viable modality that preserves myocardial function and restores LAD flow in patients with diffuse atherosclerotic LAD. Also postoperative adverse effects were minimal while mid-term flow reserve was affected by preoperative factors.
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Affiliation(s)
- Charalampos Katselis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Samanidis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | - George Karatasakis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ioannis Nenekidis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eftichia Demerouti
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Theofani Antoniou
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Konstantinos Perreas
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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Durante A, Foglia Manzillo G, Burzotta F, Trani C, Aurigemma C, Summaria F, Patrizi R, Talarico GP, Latib A, Figini F, Romagnoli E, De Vita M, Fantoni C, My L, Larosa C, Manzoli A, Turturo M, Berni A, Corrado G. Long term follow-up of "full metal jacket" of de novo coronary lesions with new generation Zotarolimus-eluting stents. Int J Cardiol 2016; 221:1008-12. [PMID: 27441483 DOI: 10.1016/j.ijcard.2016.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diffuse coronary artery disease treatment still remains a challenge for interventional cardiologists and cardiac surgeons. There are few data on full metal jacket (FMJ) stenting, especially with new-generation drug-eluting stents. We aimed to assess the efficacy and safety of FMJ with new-generation Zotarolimus-eluting stents (n-ZES). METHODS AND RESULTS All patients who underwent FMJ with n-ZES (≥60mm stent length) in eleven Italian interventional centers participating in the Clinical Service® project were included in this analysis. The project population consisted of 120 patients and 122 lesions. Mean age was 67±10years and 95 (79.2%) patients were male. A chronic total occlusion was present in 34 lesions (27.9%). The number of stents implanted per lesion was 2.9±0.8, and the diameter of the stents was 3.0±0.5mm. Predilation and post-dilatation were performed in 107 (87.7%) and 92 (75.4%) patients, respectively. At 41±21month follow-up there were 2 patients with subacute definite stent thrombosis, 6 patients (5.0%) had cardiac death and 5 patients (4.2%) had non-fatal myocardial infarction. Seven patients (5.8%) underwent clinically-driven target lesion revascularization. Fourteen patients (11.7%) had at least one major adverse cardiac event. CONCLUSION The treatment of diffuse coronary artery disease with FMJ stenting with n-ZES appears to be effective and safe. Late and very-late ST does not seem to be an issue and the rate of restenosis and of major cardiac adverse events after more than 3-year follow-up is rather low.
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Affiliation(s)
- Alessandro Durante
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy.
| | | | - Francesco Burzotta
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina Aurigemma
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Azeem Latib
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Filippo Figini
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Enrico Romagnoli
- Unità di Emodinamica e Cardiologia Interventistica - Ospedale di Belcolle, Viterbo, Italy
| | - Mariarosaria De Vita
- Unità Operativa Di Cardiologia, Azienda Ospedaliera Morgagni Pierantoni, Forlì, Italy
| | - Cecilia Fantoni
- Unità Operativa Di Cardiologia, Istituto Clinico Humanitas Mater Domini, Castellanza, Italy
| | - Luigi My
- Unità di Cardiologia, Casa di Cura Villa Verde, Taranto, Italy
| | - Claudio Larosa
- Unità Di Cardiologia, Ospedale Lorenzo Bonomo, Andria, Italy
| | - Alessandro Manzoli
- Unità di Emodinamica e Cardiologia Interventistica, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Maurizio Turturo
- UOC Cardiologia, Presidio Ospedaliero Di Venere, Bari Carbonara, Italy
| | - Andrea Berni
- UOC Cardiologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | - Giovanni Corrado
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy
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Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: The current state of knowledge. Atherosclerosis 2016; 249:88-98. [DOI: 10.1016/j.atherosclerosis.2016.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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Nemati MH, Astaneh B, Khosropanah S. Outcome and graft patency in coronary artery bypass grafting with coronary endarterectomy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:13-24. [PMID: 25705593 PMCID: PMC4333844 DOI: 10.5090/kjtcs.2015.48.1.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/26/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66±3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. Results Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88±0.39 vs. 2.70±0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. Conclusion The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.
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Affiliation(s)
| | - Behrooz Astaneh
- Medical Journalism Department, Paramedical School, Shiraz University of Medical Sciences
| | - Shahdad Khosropanah
- Cardiology Department, Medical School, Shiraz University of Medical Sciences
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Qiu Z, Chen X, Jiang Y, Wang L, Xu M, Huang F, Shi H, Zhang C. Comparison of off-pump and on-pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome. J Cardiothorac Surg 2014; 9:186. [PMID: 25471231 PMCID: PMC4266222 DOI: 10.1186/s13019-014-0186-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary endarterectomy (CE) is an alternative for the diffusely diseased left anterior descending (LAD), but its mid and long term results are largely questionable. This study is to compare the early to mid-term results between off-pump and on-pump coronary endarterectomy with coronary artery bypass grafting. METHODS 212 consecutive patients underwent CE and bypass grafting for diffusely diseased LAD. Ninety-two patients undergoing CE with off-pump (group off-pump) were compared with 120 patients undergoing CE with on-pump (group on-pump). The main preference for selection to an off-pump CE surgery were the preoperative high risk factors, especially previous cerebrovascular accident、chronic obstructive pulmonary disease (COPD)、calcified ascending aorta and right coronary artery (RCA) critical stenosis >90%. RESULTS There were three deaths in this group with total operative mortality of 1.4%. The perioperative mortality of group off-pump (1.1%) was similar with that of group on-pump (1.7%). The postoperative myocardial infarctions rate was 2.8%. There was no significant difference as for the morbidity between the group off-pump and group on-pump. Among survivors, the patency rate of the LIMA-LAD anastomosis was 89.4%. There was no difference as for the grafts patency rate between the two groups. Kaplan-Meier survival revealed no significant difference between the two groups. Kaplan-Meier freedom from cardiac events requiring hospital re-admission and angina recurrence were similar in both groups. CONCLUSIONS On-pump or off-pump CE is a good technique with the same early and mid-term outcomes. In the series of off-pump CE, we have shown that the effect of OPCABG with CE appears to be durable, and mid-term clinical outcomes are encouraging. Despite the higher risk profile, hospital mortality and major complications in our study are comparable to those for CCE.
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Affiliation(s)
- Zhibing Qiu
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - Xin Chen
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - YingShou Jiang
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - LiMing Wang
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - Ming Xu
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - Fuhua Huang
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - Hongwei Shi
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
| | - Cui Zhang
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing Heart Institute, 68 Changle Rd, 210006, Nanjing, China.
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Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg 2014; 19:462-73. [DOI: 10.1093/icvts/ivu157] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coronary endarterectomy for the diffusely diseased coronary artery. Gen Thorac Cardiovasc Surg 2014; 62:461-7. [DOI: 10.1007/s11748-014-0414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Indexed: 10/25/2022]
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Coronary endarterectomy: new flavors from old recipes. J Cardiol 2014; 63:397-401. [PMID: 24674746 DOI: 10.1016/j.jjcc.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
Abstract
Coronary endarterectomy is an old surgical procedure against coronary artery disease first described by Baily et al. in 1957. Despite its first adverse results, several current publications have shown that coronary endarterectomy with on-pump or off-pump coronary artery bypass grafting can be safely performed with acceptable mortality, morbidity, and angiographic patency rates. Coronary endarterectomy can assure complete revascularization supplying the myocardium with satisfactory blood flow in cases of a diffusely diseased left anterior descending artery or diffuse calcification, thus preventing residual ischemia. Hence, it is important to evaluate current results, rethink this old recipe, and redefine its indications.
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Gucu A, Goncu T, Yavuz S, Ozluk OA, Eris C, Turk T, Ozyazıcıoglu A, Vural H. Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing complete myocardial revascularization. Int J Clin Exp Med 2014; 7:142-147. [PMID: 24482700 PMCID: PMC3902252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/30/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The basic aim of surgical interventions in patients with coronary artery disease is to complete myocardial revascularization. In such patients, however, complementary revascularization techniques may require in patients with multisegmental left anterior descending disease. Among the different procedures, we performed an alternative option in patients with multisegmental lad disease for providing complete myocardial revascularization. METHODS This study consists of retrospective analysis of consecutive eight patients between january 2008 and august 2013. In all patients, the surgical procedure consisted of standard aortic and right atrial cannulations followed by coronary artery bypass grafting with cardiopulmonary bypass. At the lesions of non-lad vessels distal anastomoses were performed with saphenous vein graft. After that lad arteriotomies were performed at the proximal and the distal segment of coronary stenosis, and a bridge was formed with a short segment valveless svg. The left internal mammary artery was anastomosed on the bridge. RESULTS This innovative technique was performed successfully in all the patients. There were no morbidity and in-hospital mortality. At follow-up 1 year control, all the patients have no complications. In 2 patients, control angiogram showed a patent lima to a bridge anastomosis. CONCLUSIONS Although our series has a small group population, we advocate that this is a safe, easy, and efficient technique for providing complete revascularization in multisegmental lad disease. This technique could be performed with the good result and easy implementation. It perfuses both the proximal and the distal segments of the multisegmental lad stenoses.
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Affiliation(s)
- Arif Gucu
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Tuğrul Goncu
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Senol Yavuz
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Ozlem Arican Ozluk
- Department of Cardiology, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Cuneyt Eris
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Tamer Turk
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Ahmet Ozyazıcıoglu
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
| | - Hakan Vural
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research HospitalBursa, Turkey
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Alreshidan M, Albabtain M, Obied H, Alassal M, Albaradai A, Alghofaili F. Does Coronary Endarterectomy Increase Early Mortality and Morbidity Compared with Coronary Artery Bypass Surgery Alone-Single Centre Experience. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.55033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Binsalamah ZM, Al-Sarraf N, Chaturvedi RK, Alam A, Thalib L, Belley G, Shum-Tim D. Mid-term outcome and angiographic follow-up of endarterectomy of the left anterior descending artery in patients undergoing coronary artery bypass surgery. J Card Surg 2013; 29:1-7. [PMID: 24131089 DOI: 10.1111/jocs.12230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM With the advancement of percutaneous coronary interventions (PCIs), more patients with diffuse coronary artery disease are referred for coronary artery bypass graft (CABG) surgery. The use of coronary endarterectomy may be useful in such cases. We reviewed our experience with left anterior descending artery endarterectomy as an adjunct to conventional CABG. METHODS Between June 2005 and 2011, 58 consecutive patients underwent left anterior descending artery endarterectomy as an adjunct to CABG. These were matched to 58 cases based on age, gender, and Parsonnet score. All data were collected prospectively in a departmental database. Postoperative complications and in-hospital mortality were analyzed. Survival curves were produced. RESULTS There was one death in the endarterectomy group (1.7%) from liver failure. There was no significant difference in postoperative complications (especially perioperative myocardial infarction) between the two groups with similar hospital mortality. Computed tomography (CT) angiography was performed in 24 patients with endarterectomy (41%), which showed 100% patency of the left internal mammary artery graft to the left anterior descending artery. Survival and freedom from intervention at a mean follow-up of 4.2 years were similar. CONCLUSIONS In patients with diffuse disease, the use of endarterectomy is a safe technique with no increase in short-term morbidity or mortality. Mid-term results are similar to nonendarterectomized patients. This technique is useful in patients with diffuse coronary artery disease.
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Affiliation(s)
- Ziyad M Binsalamah
- Department of Surgery, Division of Cardiac Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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Nour S, Yang D, Dai G, Wang Q, Feng M, Lila N, Chachques JC, Wu G. Intrapulmonary shear stress enhancement: a new therapeutic approach in acute myocardial ischemia. Int J Cardiol 2013; 168:4199-208. [PMID: 23932859 DOI: 10.1016/j.ijcard.2013.07.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 02/18/2013] [Accepted: 07/13/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ischemic heart disease (IHD) is a leading cause of mortality with insufficient results of current therapies, most probably due to maintained endothelial dysfunction conditions. Alternatively, we propose a new treatment that promotes endothelial shear stress (ESS) enhancement using an intrapulmonary pulsatile catheter. METHODS Twelve piglets, divided in equal groups of 6: pulsatile (P) and non-pulsatile (NP), underwent permanent left anterior descending coronary artery ligation through sternotomy. After 1 h of ischemia and heparin injection (150 IU/kg): in P group, a pulsatile catheter was introduced into the pulmonary trunk and pulsated intermittently over 1 h, and irrespective of heart rate (110 bpm). In NP group, nitrates were given (7 ± 2 mg/kg/min) for 1 h. RESULTS In P group all 6 animals survived ischemia for 120 min, but in NP group only 2 animals survived. The 4 animals that died during the experiment in NP group survived for 93 ± 14 min. Hemodynamics and cardiac output (CO) were significantly improved in P group compared with NP group: CO was 0.92 ± 0.15 vs. 0.52 ± 0.08 in NP group (L/min; p < 0.05), respectively. Vascular resistances (dynes.s.cm(-5)/kg) were significantly (p < 0.05) lower in P group versus NP group: pulmonary resistance was 119 ± 13 vs. 400 ± 42 and systemic resistance was 319 ± 43 vs. 1857 ± 326, respectively. Myocardial apoptosis was significantly (p < 0.01) lower in P group (0.66 ± 0.07) vs. (4.18 ± 0.27) in NP group. Myocardial endothelial NO synthase mRNA expression was significantly (p < 0.01) greater in P group (0.90 ± 0.09) vs. (0.25 ± 0.04) in NP group. CONCLUSIONS Intrapulmonary pulsatile catheter could improve hemodynamics and myocardial contractility in acute myocardial ischemia. This represents a cost-effective method, suitable for emergency setting as a first priority, regardless of classical coronary reperfusion.
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Affiliation(s)
- Sayed Nour
- Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, University Paris Descartes, 75015 Paris, France; Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Ariyaratnam P, Javangula K, Papaspyros S, McCrum-Gardner E, Nair RU. Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease. Eur J Cardiothorac Surg 2012; 42:e140-5. [DOI: 10.1093/ejcts/ezs510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Robotically assisted coronary endarterectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 6:391-4. [PMID: 22436776 DOI: 10.1097/imi.0b013e318237cff4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Robotic assistance has enabled coronary artery bypass surgery to be performed safely in a completely endoscopic fashion, but diffusely diseased target vessels may pose a technical challenge. We present a case in which coronary endarterectomy was performed on the left anterior descending coronary artery during a two-vessel totally endoscopic coronary artery bypass procedure. A 52-year-old woman presented with intermittent substernal pain. Preoperative studies showed diffuse disease in the left coronary artery system. Bilateral internal mammary arteries were harvested robotically using a skeletonized technique in a completely endoscopic fashion. Cardiopulmonary bypass was achieved via peripheral cannulation, and the heart was arrested with intermittent cold antegrade hyperkalemic blood cardioplegia delivered via an ascending aortic occlusion balloon catheter. The first obtuse marginal anastomosis was performed. The left anterior descending coronary artery was diffusely diseased and heavily calcified. An end-to-side anastomosis was attempted to the right internal mammary artery with unsatisfactory results. A localized coronary endarterectomy was performed, and an extended anastomosis was completed using the right internal mammary artery. The patient recovered uneventfully and was discharged home on postoperative day 6. Diffuse coronary artery disease was once thought to be a prohibitive challenge for minimally invasive coronary bypass procedures. This case demonstrates that local coronary endarterectomy is feasible and safe in robotic totally endoscopic coronary artery bypass surgery.
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Schotola H, Sossalla S, Rajab TK, Toischer K, Quintel M, Bauer M, Schmitto JD. Influence of mild metabolic acidosis on cardiac contractility and isoprenaline response in isolated ovine myocardium. Artif Organs 2012; 35:1065-74. [PMID: 22097981 DOI: 10.1111/j.1525-1594.2011.01390.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The postoperative course after major surgical procedures such as cardiothoracic operations is often accompanied by acute metabolic abnormalities due to large volume and temperature shifts. In general, those intervention-induced trauma might cause the use of catecholamines to stabilize hemodynamics. Within the cardiac community, there are still controversial discussions about standardized medical therapy to treat postoperative acidosis, for example, buffering versus nonbuffering for improving catecholaminergic response of myocardial contractility. The aim of this study was to investigate the influence of mild (and thus clinically relevant) acidosis on myocardial contractility and catecholamine response in explanted trabeculae of ovine hearts. Intact trabeculae (n = 24) were isolated from the right ventricle of healthy sheep hearts. Two different groups (group 1: pH = 7.40, n = 9 and group 2: pH = 7.20, n = 13) were investigated, and force amplitudes were measured at frequencies between 30 and 180 beats per minute and increasing catecholamine concentrations (isoprenaline 0-3 × 10(-6) mM). Force-frequency relation experiments in the presence of a physiological and/or mild acidotic pH solution showed no significant differences. Mean force amplitudes normalized to the lowest frequency showing no significant differences in force development between 0.5 and 3 Hz (n = 9 vs. 13, P = n.s.) (0.5 Hz absolute values 3.1 ± 2.6 for pH = 7.40 vs. 3.8 ± 2.6 mN/mm(2) for pH = 7.20, P = n.s.). Moreover, there was no significant difference in relaxation kinetics between the two groups. Furthermore, the experiments showed similar catecholamine responses in both groups. Force amplitudes normalized to baseline and maximum force showed no significant differences in force development between baseline and maximum isoprenaline concentrations (n = 6 vs. 9, P = n.s.) (baseline absolute values 4.3 ± 4.0 for pH = 7.40 vs. 3.9 ± 1.2 mN/mm(2) for pH = 7.20, P = n.s.). Additionally, relaxation kinetics did not show differences after catecholamine stimulation. The presented experiments revealed no significant negative inotropic effects on isometrically contracting ovine trabeculae with mild metabolic acidosis (pH = 7.2) compared with physiological pH (7.4). Additionally, similar catecholamine responses were seen in both groups. Further investigations (e.g., in vivo and/or in failing hearts with reduced compensatory reserves) will be necessary to examine optimal medical treatment for metabolic abnormalities after cardiac surgery.
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Affiliation(s)
- Hanna Schotola
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Goettingen, Goettingen, Germany
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Dawood MY, Lehr EJ, de Biasi A, Haque R, Grigore A, Griffith BP, Bonatti JO. Robotically Assisted Coronary Endarterectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Murtaza Y. Dawood
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | - Andreas de Biasi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Reyaz Haque
- Division of Cardiology, and Department of Anesthesia, Baltimore, MD USA
| | - Alina Grigore
- Department of Anesthesia, University of Maryland School of Medicine, Baltimore, MD USA
| | - Bartley P. Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Johannes O. Bonatti
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
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30
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Mert M, Cetin G, Yildiz CE, Ugurlucan M, Caglar IM, Ozkara A, Akcevin A, Bakay C. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease. J Cardiothorac Surg 2010; 5:87. [PMID: 20958964 PMCID: PMC2984402 DOI: 10.1186/1749-8090-5-87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/19/2010] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. PATIENTS AND METHODS In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. RESULTS Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). CONCLUSION We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.
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Affiliation(s)
- Murat Mert
- Department of Cardiovascular Surgery, Instiute of Cardiology, Istanbul University, Istanbul, Turkey.
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31
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Huang WH, Lee JF, Wang D, Gou WH, Chang CY, Wei J. Postischemia myocardial injury in coronary artery bypass patients (PP6). Transplant Proc 2010; 42:725-8. [PMID: 20430157 DOI: 10.1016/j.transproceed.2010.02.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the reperfusion injury of the myocardium in patients undergoing elective coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB), we monitored the blood levels of troponin I (TNI), white blood cells, oxygen radicals, malondialdehyde, and myeloperoxidase seeking to define the relationship between the CABG-induced systemic inflammation and myocardial injury. MATERIALS AND METHODS We selected 10 patients undergoing primary CABG with CPB at moderate hypothermia and cardioplegic arrest concomitant with intermittent warm blood cardioplegia. We compared all data with their own baseline values to study the reperfusion injury. After release of the aortic clamp, blood was drawn from the coronary sinus, via a catheter placed through the right atrium. We measured plasma levels of inflammatory mediators, such as malondialdehyde, myeloperoxidase, oxygen radicals, and the myocardium injury parameter of TNI. RESULTS Patients showed no difference concerning aortic clamp time. TNI increased significantly at 1, 15, and 30 minutes after the onset of reperfusion. Blood levels of white blood cells, oxygen radicals, malondialdehyde, and myeloperoxidase also increased significantly with reperfusion time. CONCLUSIONS Reperfusion of ischemic myocardium induced increased TNI, which may be related to the systemic inflammatory responses induced by ischemia and reperfusion of the myocardium among patients undergoing elective coronary bypass surgery.
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Affiliation(s)
- W H Huang
- Department of Medicine, Weigong Memorial Hospital, Miouli, County, Taiwan
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