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Tiemuerniyazi X, Yang Z, Song Y, Xu F, Zhao W, Feng W. Coronary endarterectomy combined with coronary artery bypass grafting might decrease graft patency: A cohort study. Hellenic J Cardiol 2024; 76:40-47. [PMID: 37437778 DOI: 10.1016/j.hjc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/13/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Little is known about the graft patency after coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG). This study aimed to investigate the graft patency after CABG + CE. METHODS Eligible patients hospitalized at our center during September 2008 and July 2022 with complete follow-up coronary angiographic data available were retrospectively enrolled. The primary end point was the follow-up graft patency of CE targets. Logistic regression was performed to explore the potential predictors of the CE-targeted graft failure. RESULTS A total of 160 patients (age: 59.4 ± 9.3 years, male: 75.6%) were enrolled, and 560 grafts were anastomosed. CE was performed on 166 sites, including LAD (36.1%), right coronary artery (RCA, 48.2%), left circumflex artery (9.6%), and diagonal branches (6.0%). Postoperative myocardial infarction was observed in 7 (4.4%) of the patients. During a median follow-up of 12.1 months, the CE-targeted graft patency was 69.9%. The CE-targeted graft patency rate was much higher among the LAD-CE patients than the non-LAD-CE patients (80.0% vs. 64.2%, P = 0.032) but lower than non-endarterectomized LAD (80.0% vs. 92.9%, P = 0.013). No difference was observed regarding the graft patency between off-pump and on-pump surgery (P = 0.585). In the logistic regression, RCA-CE was associated with an increased risk of graft failure even after multiple adjustments (odds ratio: 2.35, 95% confidence interval: 1.05-5.28, P = 0.028). CONCLUSIONS CABG + CE might be associated with decreased graft patency, especially in those who received RCA-CE, irrespective of surgical technique or antiplatelet/anticoagulation regimen. A multi-center prospective, possibly randomized study with a larger sample size is warranted.
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Affiliation(s)
- Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziang Yang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Thakare VS, Sontakke NG, Wasnik P, Kanyal D. Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review. Cureus 2023; 15:e45511. [PMID: 37868547 PMCID: PMC10585183 DOI: 10.7759/cureus.45511] [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: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Coronary artery bypass grafting (CABG) has witnessed remarkable progress in recent years, driven by innovative techniques and refined approaches that have transformed patient outcomes and treatment paradigms. This review article comprehensively explores the latest advances in CABG techniques and their consequential impacts on patient outcomes. The advent of minimally invasive CABG techniques has revolutionized traditional surgical approaches. Robotic-assisted surgery and small thoracotomy methods offer reduced invasiveness, yielding shorter recovery times and improved patient satisfaction. Integrating CABG with percutaneous coronary intervention (PCI), hybrid procedures have emerged as a versatile strategy, providing tailored treatment solutions for complex coronary anatomies. The paradigm shift to off-pump CABG, which preserves the beating heart during surgery, has shown promise in reducing perioperative complications and neurocognitive deficits. Advances in graft selection, particularly the utilization of arterial grafts such as the internal thoracic artery and radial artery, have significantly enhanced graft patency rates and long-term survival. Adjunctive technologies, such as intraoperative imaging and graft flow assessment, have bolstered the precision of CABG procedures. Pharmacological agents have demonstrated their potential to improve graft outcomes. Surgical decision-making is now optimized based on patient characteristics and disease severity owing to the development of patient selection and risk stratification tools. Long-term results have also significantly improved. Patients undergoing CABG have higher survival rates, less angina, and better quality of life. Developing more resilient grafts through tissue engineering, using bioresorbable materials in graft fabrication, and using gene therapy to improve graft patency and overall cardiac recovery are all exciting future research directions. This review's summary of current developments in CABG procedures highlights their profoundly positive effects on patient outcomes. These developments can change the face of cardiovascular care by giving clinicians more tools to treat coronary artery disease (CAD) and enhance patients' quality of life.
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Affiliation(s)
- Vaishnavi S Thakare
- Hospital Administration, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil G Sontakke
- Health Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Praful Wasnik
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepika Kanyal
- Hospital Administration, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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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Wu Z, Liu C, Fang Y, Wei H, Gu C. Intraoperative intra-aortic balloon pump improves 30-day outcomes of patients undergoing extensive coronary endarterectomy. J Cardiothorac Surg 2020; 15:223. [PMID: 32819396 PMCID: PMC7439531 DOI: 10.1186/s13019-020-01261-5] [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] [Received: 03/03/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of intra-aortic balloon pump (IABP) has been proven in high-risk patients undergoing coronary artery bypass grafting (CABG). However, data on the timing and benefits of IABP support in diffuse coronary artery disease after CABG combined with coronary endarterectomy (CE) remain scarce. This retrospective study assessed the effect of intraoperative or postoperative IABP on 30-day outcomes of off-pump CABG+CE. METHODS From January 2012 to December 2018, 546 patients undergone off-pump CABG+CE were divided into control group (n = 437) and IABP group (n = 109). Risk factors for 30-day outcomes were evaluated. Subgroup analysis from IABP group was conducted to identify the effect of timing IABP on 30-day outcomes. RESULTS CE on left anterior descending branch of coronary artery (LAD) (OR = 3.079, 95% CI 1.077-8.805, P = 0.036), CE with≥2 vessels (OR = 9.123, 95% CI 3.179-26.033, P < 0.001) and length of atherosclerotic plaque ≥3 cm (OR = 16.017, 95% CI 5.941-43.183, P < 0.001) were independent risk factors for postoperative acute myocardial infarction (AMI) and 30-day mortality. Comparing with intraoperative IABP support, postoperative IABP support (OR = 3.987, 95% CI1.194-13.317, P = 0.025) was closely associated with postoperative AMI and 30-day mortality. CONCLUSIONS For patients undergone off-pump CABG and extensive CE (CE on LAD, CE ≥2 vessels and length of atherosclerotic plaque ≥3 cm), intraoperative IABP support may improve 30-day outcomes.
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Affiliation(s)
- Zhen Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Anzhen Street No.2 Chaoyang District, Beijing, 100029, China
| | - Changcheng Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Anzhen Street No.2 Chaoyang District, Beijing, 100029, China
| | - Ying Fang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Anzhen Street No.2 Chaoyang District, Beijing, 100029, China
| | - Hua Wei
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Anzhen Street No.2 Chaoyang District, Beijing, 100029, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Anzhen Street No.2 Chaoyang District, Beijing, 100029, China.
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