Outcomes of Off-Pump Coronary Artery Bypass with Coronary Endarterectomy in Advanced Diffuse Atherosclerotic Coronary Artery Disease
Outcomes of OPCAB with CE in Advanced diffuse CAD
Keywords:
Coronary endarterectomy, Off-Pump coronary artery bypass, Diffuse atheroscleroticAbstract
Background: Coronary endarterectomy (CE) is an optional modality for advanced diffuse atherosclerotic coronary artery disease (CAD) to complete surgical revascularization. This strategy is still debatable in the existing guidelines, particularly in off-pump coronary artery bypass (OPCAB). We present a single-center’s experience with this technique.
Materials and Methods: We conducted a retrospective analysis in 17 patients, who underwent OPCAB surgery with coronary endarterectomy (CE) from January 2013 until December 2017. The air of study is to evaluate 30-days mortality and complications with this technique.
Results: This study included 17 patients (15 men and 2 women, mean age of 58.88±7.69 years old). Sixteen out of seventeen patients (94.1%) were performing closed endarterectomy technique and another one patient was use open endarterectomy technique. There was no mortality observed during 30-days postoperative period but one late mortality (at 6 months post-operation) due to multiple organs failure. Three patients (17.65%) developed post-operative atrial fibrillation (POAF) and 2 patients (11.76%) had hospital acquired pneumonia with mean hospital stay of 12 days (ranged from 8-40 days).
Conclusion: Advanced diffuse CAD is still challenging condition for coronary revascularization, OPCAB with CE can be an alternative procedure with low mortality and acceptable complications under high-experienced surgeon, however, long-term clinical outcomes and post-operative angiographic data are needed for further study.
References
Bell MR, Gersh BJ, Schaff HV, et al. Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery. A report from the Coronary Artery Surgery Study (CASS) Registry. Circulation 1992;86:446-57.
Lawrie GM, Morris GC Jr, Silvers A, et al. The influence of residual disease after coronary bypass on the 5-year survival rate of 1274 men with coronary artery disease. Circulation 1982;66:717-23.
Jones EL, Craver JM, Guyton RA, et al. Importance of complete revascularization in performance of the coronary bypass operation. Am J Cardiol 1983;51:7-12.
Bailey CP, May A, Lemmon WM. Survival after coronary endarterectomy in man. J Am Med Assoc 1957;164:641-6.
Livesay JJ, Cooley DA, Hallman GL, et al. Early and late results of coronary endarterectomy. Analysis of 3,369 patients. J Thorac Cardiovasc Surg 1986;92:649-60.
Brenowitz JB, Kayser KL, Johnson WD. Results of coronary artery endarterectomy and reconstruction. J Thorac Cardiovasc Surg 1988;95:1-10.
Minale C, Nikol S, Zander M, et al. Controversial aspects of coronary endarterectomy. Ann Thorac Surg 1989;48:235-41.
Sahan E, Sahan S, Karamanlıoglu M, et al. The impact of the extent and severity of coronary artery disease on fractional flow reserve measurements. Eur Rev Med Pharmacol Sci 2016;20:343-9.
Anderson HV, Stokes MJ, Leon M, et al. Coronary artery flow velocity is related to lumen area and regional left ventricular mass. Circulation 2000;102:48-54.
Careaga Reyna G, Salazar Garrido D, Tellez Luna S, Arguero Sanchez R. Coronary endarterectomy and bypass grafting without cardiopulmonary bypass. Rev Espan Cardiol 2003;56:515-8.
Darwazah AK, Abu Sham’a RA, Yasin IH. Coronary endarterectomy on beating heart: is it worth doing? J Card Surg 2007;22:69-72.
Eryilmaz S, Inan MB, Eren NT, et al. Coronary endarterectomy with off-pump coronary artery bypass surgery. Ann Thorac Surg 2003;75:865-9.
Takahashi M, Gohil S, Tong B, et al. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg 2013;16:301-5.
Vohra HA, Kanwar R, Khan T, Dimitri WR. Early and late outcome after off-pump coronary artery bypass graft surgery with coronary endarterectomy: a single-center 10-year experience. Ann Thorac Surg 2006;81:1691-6.
Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/ EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). J Eur Assoc Cardiothoracic Surg 2014;46:517-92.
Parsonnet V, Gilbert L, Gielchinsky I, Bhaktan EK. Endarterectomy of the left anterior descending and mainstem coronary arteries: a technique for reconstruction of inoperable arteries. Surgery 1976;80:662-73.
Soylu E, Harling L, Ashrafian H, Athanasiou T. Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy? Interact Cardiovasc Thorac Surg 2014;19:295-301.
Naseri E, Sevinc M, Erk MK. Comparison of off-pump and conventional coronary endarterectomy. Heart Surg Forum 2003;6:216-9.
Hussain I, Ghaffar A, Shahbaz A, et al. In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG. J Ayub Med Coll 2008;20:31-7.
Gol MK, Yilmazkaya B, Goksel S, et al. Results of right coronary artery endarterectomy with or without patch-plasty. J Card Surg 1999;14:75-81.
Nishi H, Miyamoto S, Takanashi S, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg 2005;79:846–52.
Kunt AS, Darcin OT, Demirbag R, Andac MH. Coronary endarterectomy with beating heart in patients with diffuse atheromatous coronary artery disease and poor ventricular function: early and midterm results. Heart Surg Forum 2005;8:E124-8.
Nurozler F, Kutlu T, Kucuk G, Okten C. Off-pump coronary endarterectomy in high-risk patients. Asian Cardiovasc Thorac Ann 2006;14: 227-30.
W. Domaradzki , K. Sanetra, J. Krauze, et al. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting–midterm mortality and morbidity. Kardiochirurgia i Torakochirurgia Polska 2015;12:304-8.
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