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Zhang W, Wu H. Outcomes of coronary artery bypass grafting with coronary endarterectomy: A systematic review and meta-analysis of recent studies. Perfusion 2024; 39:489-498. [PMID: 36530039 DOI: 10.1177/02676591221147418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Objective: The aim of this systematic review and meta-analysis was to evaluate the short-term and long-term outcomes of coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) versus isolated CABG.Methods: Studies evaluating outcomes of CABG with CE (CE-CABG) were searched from 1 January 2000 to 30 September 2022, on PubMed, Embase, and Cochrane databases. The primary outcome was 30 -days mortality. Secondary outcomes were postoperative myocardial infraction, low output syndrome, cardiac arrhythmia, renal dysfunction, and 5 years survival.Results: A total of 12 observational studies including 114,319 patients assessing CE-CABG (n = 35,174) versus isolated CABG (n = 79,145) were included. Compared to isolated CABG alone, CE-CABG was significantly associated with increased incidences of 30-days mortality (RR, 1.87; 95% CI, 1.73-2.07; p < 0.01), postoperative myocardial infraction (RR, 1.61; 95% CI, 1.26-2.05; p < 0.01), low output syndrome (RR, 1.54; 95% CI, 1.17-2.02; p < 0.01), and renal dysfunction (RR, 1.56; 95% CI, 1.44-1.69; p < 0.01). However, there was no difference in either rate of cardiac arrhythmia (RR, 1.06; 95% CI, 0.97-1.15; p = 0.20) or 5 years survival (RR, 1.05; 95% CI, 0.95-1.16; p = 0.34) between the CE-CABG group and the control group. Subgroup analysis on CE technique showed that CE-CABG was also associated with 30 days mortality in patients undergoing closed CE (RR, 1.49; 95% CI, 1.09-2.03), whereas this association between CE and 30 days mortality was not observed in patients undergoing open CE (RR, 1.76; 95% CI, 0.58-5.32).Conclusions: Despite poor short-term outcomes, CE-CABG appeared to offer satisfactory long-term survival in patients with diffuse coronary artery disease.
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Affiliation(s)
- Wei Zhang
- Department of Cardiothoracic Surgery, Changzhi People's Hospital, Changzhi, China
| | - Haibo Wu
- Department of Cardiothoracic Surgery, Changzhi People's Hospital, Changzhi, China
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Cao L, Ni H, Gong X, Zang Z, Chang H. Chinese Herbal Medicines for Coronary Heart Disease: Clinical Evidence, Pharmacological Mechanisms, and the Interaction with Gut Microbiota. Drugs 2024; 84:179-202. [PMID: 38265546 DOI: 10.1007/s40265-024-01994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
Coronary heart disease (CHD) is a common type of cardiovascular disease (CVD) that has been on the rise in terms of both incidence and mortality worldwide, presenting a significant threat to human health. An increasing body of studies has shown that traditional Chinese medicine (TCM), particularly Chinese herbal medicines (CHMs), can serve as an effective adjunctive therapy to enhance the efficacy of Western drugs in treating CHD due to their multiple targets and multiple pathways. In this article, we critically review data available on the potential therapeutic strategies of CHMs in the intervention of CHD from three perspectives: clinical evidence, pharmacological mechanisms, and the interaction with gut microbiota. We identified 20 CHMs used in clinical practice and it has been found that the total clinical effective rate of CHD patients improved on average by 17.78% with the intervention of these CHMs. Subsequently, six signaling pathways commonly used in treating CHD have been identified through an overview of potential pharmacological mechanisms of these 20 CHMs and the eight representative individual herbs selected from them. CHMs could also act on gut microbiota to intervene in CHD by modulating the composition of gut microbiota, reducing trimethylamine-N-oxide (TMAO) levels, increasing short-chain fatty acids (SCFAs), and maintaining appropriate bile acids (BAs). Thus, the therapeutic potential of CHMs for CHD is worthy of further study in view of the outcomes found in existing studies.
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Affiliation(s)
- Linhai Cao
- College of Food Science, Southwest University, No. 2 Tiansheng Road, BeiBei District, Chongqing, 400715, China
| | - Hongxia Ni
- College of Food Science, Southwest University, No. 2 Tiansheng Road, BeiBei District, Chongqing, 400715, China
| | - Xiaoxiao Gong
- College of Food Science, Southwest University, No. 2 Tiansheng Road, BeiBei District, Chongqing, 400715, China
| | - Ziyan Zang
- College of Food Science, Southwest University, No. 2 Tiansheng Road, BeiBei District, Chongqing, 400715, China
| | - Hui Chang
- College of Food Science, Southwest University, No. 2 Tiansheng Road, BeiBei District, Chongqing, 400715, China.
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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.
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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.
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Zorc-Pleskovič R, Zorc M, Šuput D, Milutinović A. Inflammatory cells in perivascular adipose tissue and the integrity of the tunica media in atherosclerotic coronary arteries. Bosn J Basic Med Sci 2020; 20:183-187. [PMID: 31562801 PMCID: PMC7202195 DOI: 10.17305/bjbms.2019.4409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
Obstructive coronary artery disease (CAD) is characterized by inflammation within the atherosclerotic coronary arteries. Infiltration of inflammatory cells into muscular media can lead to remodeling and weakening of the arterial wall. We examined the relationship between inflammatory infiltration in perivascular adipose tissue (PVAT), state of the external elastic membrane, and the intensity of inflammatory infiltration in the tunica media of coronary arteries obtained by endarterectomy from symptomatic patients with diffuse CAD. We analyzed endarterectomy sequesters from 22 coronary arteries that contained the intima, media, a part of the adventitia, and PVAT in at least one part of the sequester. The coronary arteries were divided into two groups according to the presence or absence of inflammatory infiltration in PVAT. Staining with hematoxylin-eosin and by the Movat's method showed atherosclerotic changes in the intima and media. Immunohistochemistry (anti-leukocyte common antigen [LCA] antibody) was used for the detection of leukocytes. We found a significant positive correlation between inflammatory infiltration in PVAT and preservation of the external elastic membrane of coronary arteries. Furthermore, we found a significant negative correlation between inflammatory infiltration in PVAT and the intensity of inflammatory infiltration in the media. It seems that the integrity of the external elastic membrane and the proinflammatory properties of PVAT restrain inflammatory cells within PVAT. Both effects may prevent the migration of inflammatory cells into the media and delay the development of CAD.
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Affiliation(s)
- Ruda Zorc-Pleskovič
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; International Center for Cardiovascular Diseases MC Medicor d.d., Izola, Slovenia
| | - Marjeta Zorc
- International Center for Cardiovascular Diseases MC Medicor d.d., Izola, Slovenia
| | - Dušan Šuput
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleksandra Milutinović
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Costa MACD, Betero AL, Okamoto J, Schafranski M, Reis ESD, Gomes RZ. Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries. Braz J Cardiovasc Surg 2020; 35:9-15. [PMID: 32270954 PMCID: PMC7089746 DOI: 10.21470/1678-9741-2018-0402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. METHODS We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. RESULTS There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. CONCLUSION In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.
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Affiliation(s)
- Mario Augusto Cray da Costa
- Universidade Estadual de Ponta Grossa Department of Medicine Ponta Grossa Paraná Brazil Department of Medicine, Universidade Estadual de Ponta Grossa - Campus Uvaranas, Ponta Grossa, Paraná, Brazil.,Clinica Cray da Costa Medicina e Pesquisa Ponta Grossa Paraná Brazil Clinica Cray da Costa Medicina e Pesquisa, Ponta Grossa, Paraná, Brazil
| | - André Luís Betero
- Universidade Estadual de Ponta Grossa Ponta Grossa Paraná Brazil Universidade Estadual de Ponta Grossa, Campus Uvaranas, Ponta Grossa, Paraná, Brazil
| | - Jefferson Okamoto
- Universidade Estadual de Ponta Grossa Ponta Grossa Paraná Brazil Universidade Estadual de Ponta Grossa, Campus Uvaranas, Ponta Grossa, Paraná, Brazil
| | - Marcelo Schafranski
- Universidade Estadual de Ponta Grossa Department of Medicine Ponta Grossa Paraná Brazil Department of Medicine, Universidade Estadual de Ponta Grossa - Campus Uvaranas, Ponta Grossa, Paraná, Brazil
| | - Elise Souza Dos Reis
- Universidade Estadual de Ponta Grossa Department of Medicine Ponta Grossa Paraná Brazil Department of Medicine, Universidade Estadual de Ponta Grossa - Campus Uvaranas, Ponta Grossa, Paraná, Brazil
| | - Ricardo Zanetti Gomes
- Universidade Estadual de Ponta Grossa Department of Medicine Ponta Grossa Paraná Brazil Department of Medicine, Universidade Estadual de Ponta Grossa - Campus Uvaranas, Ponta Grossa, Paraná, Brazil
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Wang C, Chen J, Gu C, Qiao R, Li J. Impact of risk factors and surgical techniques in coronary endarterectomy: a network meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:355-364. [PMID: 30982903 DOI: 10.1093/icvts/ivz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Summary
The goal of this network meta-analysis was to compare the early mortality rate of patients who underwent coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with different techniques and with isolated CABG. This analysis also evaluated potential risk factors in patients who undergo CE. Eighteen studies were included, covering 21 752 different patients, among whom 3352 underwent CE + CABG with either open or closed techniques and 18 400 underwent isolated CABG. Patients who had CE + CABG had a statistically significant higher mortality rate [odds ratio (OR) 1.76; P < 0.001]. Subgroup analyses showed that, with closed CE, mortality was 52% (OR 1.52, P = 0.001) more likely to occur, whereas with open CE, mortality was 279% (OR 3.79, P < 0.001) more likely to occur, when both were compared with isolated CABG. A network meta-analysis indicated that both the open and closed methods had poorer results than CABG alone and that the open method had a higher risk of mortality than the closed one. For risk factors, diabetes mellitus (DM), hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were significant contributors to inclusion in the CE group, whereas other risk factors showed no significant difference. However, none of these factors indicated significant correlations with the incidence of mortality between the groups. CE + CABG has a significantly higher risk of death than isolated CABG, and open CE is more risky than closed CE, even though most of the individual studies did not show that CE had a higher risk of mortality. Moreover, DM, hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were more common in the patients who had CE + CABG, but these factors may not necessarily increase the mortality risk of patients who have CE.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- People’s Hospital of Deyang City, Sichuan, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruiguo Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Abdullah HM, Khan A, Khan Afridi M, Jan A, Khan UI, Ullah W, Ahmad A, Omar M, Khan I, Khan A. A Retrospective Cohort Study on Coronary Endarterectomy Outcomes in Coronary Artery Bypass Graft Patients. Cureus 2019; 11:e4279. [PMID: 31157140 PMCID: PMC6529046 DOI: 10.7759/cureus.4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: The aim of this study is to determine the outcomes following coronary endarterectomy (CE) in patients who underwent coronary artery bypass grafting (CABG) for revascularization in our hospital. Methods: We retrospectively reviewed patients who underwent CABG over a six-month period, from November 1, 2016 to May 31, 2017 and examined their outcomes in regards to CE. Results: A total of (n=361) CABG procedures were performed in our study period, though complete records were available for only (n=254) patients. Amongst these, (n=37) patients (14.5%) required CE. Ages ranged from 43 to 75 years for these patients, (n=7) were females and (n=30) males. Comorbidities included hypertension in (n=19) patients, diabetes in (n=12) patients and hepatitis B in (n=11) patients. The right coronary artery (RCA) was the most common artery endarterectomized (n= 15), followed by the left anterior descending (LAD) (n= 10), obtuse marginal (n= 6 patients), diagonals (n=5) and ramus (n=2). Two vessels were endarterectomized in (n=4) patients. A total of (n=9) patients had two-vessel CABG, (n=16) had three-vessel CABG and (n=8) had four-vessel CABG. The left internal mammary artery (LIMA) was used in (n=25) patients. Two patients required intra-aortic balloon pump post-operatively. All the patients had received inotropic support postoperatively in the intensive care unit (ICU). There were no reports of postoperative mortality. One patient remained in the ICU for four days postoperatively, the rest of the patients were stepped down to the ward in less than four days. Conclusions: CE is a safe and viable option as an adjunct to CABG in long segment totally occluded vessels needing revascularization and reconstruction.
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Affiliation(s)
| | - Adnan Khan
- Cardiology, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Azam Jan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Uzma I Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Muhammad Omar
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Ishaq Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Arsalan Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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Off-pump onlay-patch grafting using the left internal mammary artery for a diffusely diseased left anterior descending artery: in-hospital and mid-term outcomes. Coron Artery Dis 2019; 30:354-359. [PMID: 30807293 DOI: 10.1097/mca.0000000000000724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of this study were to evaluate the in-hospital and mid-term outcomes of the off-pump onlay-patch grafting procedure using the left internal mammary artery (LIMA) for a diffusely diseased left anterior descending artery (LAD) and to identify the risk factors for postoperative LIMA graft failure in a single-center retrospective study. PATIENTS AND METHODS A total of 63 patients (52 males, 65.7±9.0 years) undergoing LAD arteriotomy with or without concomitant endarterectomy, followed by reconstruction using LIMA onlay-patch at the time of off-pump coronary artery bypass grafting at our institute from January 2014 to December 2016 were reviewed. The operative mortality, major postoperative morbidity, follow-up all-cause mortality, major adverse cardiac events at follow-up, and postoperative LIMA graft patency were analyzed. The risk factors for postoperative LIMA graft failure on the basis of baseline and surgical characteristics were identified by multivariable logistic regression analysis. RESULTS Eighteen (28.6%) patients underwent concomitant open LAD endarterectomy. The operative mortality rate was 1.6%. Major postoperative morbidity included perioperative myocardial infarction (3.2%), low cardiac output (1.6%), and reoperation for bleeding (1.6%). During the follow-up period of 24.2±9.5 months, all-cause mortality was 1.7% and the incidence of major adverse cardiac events was 6.8%. No repeat revascularization was recorded. In total, 88.1% of LIMA grafts showed FitzGibbon grade A patency determined by noninvasive coronary computed tomography angiography during follow-up. In addition, concomitant LAD endarterectomy and intraoperative LIMA graft flow were found to be independent risk factors for mid-term LIMA graft failure by multivariable logistic regression analysis (odds ratio=2.681, 95% confidence interval: 1.314-9.856, P=0.007 and odds ratio=0.932, 95% confidence interval: 0.791-0.976, P=0.021, respectively). CONCLUSION Revascularization of a diffusely diseased LAD using the off-pump LIMA onlay-patch technique results in encouraging clinical outcomes with favorable angiographic results. Concomitant LAD endarterectomy and intraoperative LIMA graft flow are associated with the risk of postoperative LIMA graft failure.
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Wang L, Hao X, Wang X, Gu C, Wang H, Hou X. Short-term outcomes of preoperative intra-aortic balloon pump use in patients undergoing adjunctive coronary endarterectomy: a retrospective observational study. Perfusion 2018; 33:426-432. [PMID: 29451075 DOI: 10.1177/0267659118759594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy. Methods: Between May 2013 and May 2016, 120 patients undergoing off-pump coronary artery bypass grafting (OPCABG) with RCA endarterectomy who received preoperative IABP support (IABP group, n=56) or who did not receive preoperative IABP support (control group, n=64) were evaluated retrospectively. Results: Patients in the IABP group had a significantly lower mean preoperative ejection fraction and a significantly higher mean EuroSCORE (both <0.05). The incidence of inferior myocardial infarction (MI) was significantly lower in the IABP group than in the control group (3.6% vs 15.6%, RR = 0.23, 95% CI 0.05-1.00, p=0.03). Hospital mortality was similar in the two groups (3.6% vs 4.7%, RR= 0.76, 95% CI 0.13-4.40, p=0.76). There were no significant differences between the two groups with respect to the rates of prolonged ventilation, low cardiac output syndrome, renal failure requiring dialysis, re-operation for bleeding or IABP-related complications. Preoperative IABP may be a protective factor of inferior MI (HR = 0.031, 95% CI 0.004-0.211, p<0.001) Conclusions: The preoperative use of IABP could reduce the incidence of postoperative MI in patients undergoing CABG with CE and seemed to shift high-risk patients into a lower-risk category.
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Affiliation(s)
- Liangshan Wang
- Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
| | - Xing Hao
- Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
| | - Xiaomeng Wang
- Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
| | - Hong Wang
- Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of China
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Zhang C, Yang S, Gai LY, Han ZQ, Xin Q, Yang XB, Yang JJ, Jin QH. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis. Chin Med J (Engl) 2017; 129:2792-2796. [PMID: 27900990 PMCID: PMC5146784 DOI: 10.4103/0366-6999.194636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve (FFR) as the gold standard. Methods: We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age, 59.6 ± 10.2 years; 76.14% of males) who underwent CCTA, invasive coronary angiography, and invasive FFR measurement. An FFR <0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoff value of 0.80. We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman's correlation coefficients. Results: Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80. Gai's score had the strongest correlation with FFR (r = −0.48, P < 0.01) and had a greater area under the curve = 0.72 (95% confidence interval: 0.61–0.82; P < 0.01) than the CACS of whole arteries and a single artery. Conclusions: Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai's plaque score was more predictive of FFR <0.80. Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.
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Affiliation(s)
- Chuang Zhang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Shuang Yang
- Department of Rheumatism, Medical College of Qing Hai University, Xining, Qinghai 810016, China
| | - Lu-Yue Gai
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Zhi-Qi Han
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qian Xin
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xiao-Bo Yang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Jun-Jie Yang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qin-Hua Jin
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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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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