eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive About the journal Supplements Abstracting and indexing Contact Instructions for authors
SCImago Journal & Country Rank

4/2018
vol. 15
 
Share:
Share:
more
 
 
abstract:
Original paper

Coronary endarterectomy: an old tool for patients currently operated on with coronary artery bypass grafting. Long-term results, risk factor analysis

Paolo Nardi, Marco Russo, Guglielmo Saitto, Emanuele Bovio, Sara Rita Vacirca, Carlo Bassano, Antonio Scafuri, Antonio Pellegrino, Giovanni Ruvolo

Kardiochirurgia i Torakochirurgia Polska 2018; 15 (4): 219-226
Online publish date: 2018/12/31
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
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.

keywords:

coronary endarterectomy, coronary artery bypass grafting

references:
Effler DB, Groves LK, Sones FM, Shirey EK. Endarterectomy in the treatment of coronary artery disease. J Thorac Cardiovasc Surg 1964; 47: 98-102.
Livesay JJ, Cooley DA, Hallman GL, Reul GJ, Ott DA, Duncan JM, Frazier OH. Early and late results of coronary endarterectomy. Analysis of 3,369 patients. J Thorac Cardiovasc Surg 1986; 92: 649-660.
Wang J, Gu C, Yu W, Gao M, Yu U. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: a meta-analysis of 63,730 patients (PRISMA). Medicine (Baltimore) 2015; 94: e1781.
Authors/Task Force members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 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). Eur Heart J 2014; 35: 2541-2619.
Rossini R, Musumeci G, Visconti LO, Bramucci E, Castiglioni B, De Servi S, Lettieri C, Lettino M, Piccaluga E, Savonitto S, Trabattoni D, Capodanno D, Buffoli F, Parolari A, Dionigi G, Boni L, Biglioli F, Valdatta L, Droghetti A, Bozzani A, Setacci C, Ravelli P, Crescini C, Staurenghi G, Scarone P, Francetti L, D’Angelo F, Gadda F, Comel A, Salvi L, Lorini L, Antonelli M, Bovenzi F, Cremonesi A, Angiolillo DJ, Guagliumi G; Italian Society of Invasive Cardiology (SICI-GISE); Italian Association of Hospital Cardiologists (ANMCO); Italian Society for Cardiac Surgery (SICCH); Italian Society of Vascular and Endovascular Surgery (SICVE); Italian Association of Hospital Surgeons (ACOI); Italian Society of Surgery (SIC); Italian Society of Anaesthesia and Intensive Care Medicine (SIAARTI); Lombard Society of Surgery (SLC); Italian Society of Maxillofacial Surgery (SICMF); Italian Society of Reconstructive Plastic Surgery and Aesthetics (SICPRE); Italian Society of Thoracic Surgeons (SICT); Italian Society of Urology (SIU); Italian Society of Orthopaedics and Traumatology (SIOT); Italian Society of Periodontology (SIdP); Italian Federation of Scientific Societies of Digestive System Diseases Lombardia (FISMAD); Association of Obstetricians Gynaecologists Italian Hospital Lombardia (AOGOI); Society of Ophthalmology Lombardia (SOL). Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies. EuroIntervention 2014; 10: 38-46.
Nardi P, Pellegrino A, Bassano C, Mani R, Chiariello GA, Zeitani J, Chiariello L. The fate at mid-term follow-up of the on-pump vs. off-pump coronary artery bypass grafting surgery. J Cardiovasc Med 2015; 16: 125-133.
Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol 2013; 62: 1421-1431.
Papakonstantinou NA, Baikoussis NG, Apostolakis E. Coronary endarterectomy: new flavors from old recipes. J Cardiol 2014; 63: 397-401.
Tiruvoipati R, Loubani M, Lencioni M, Ghosh S, Jones PW, Patel RL. Coronary endarterectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg 2005; 79: 1999-2003.
Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: the current state of knowledge. Atherosclerosis 2016; 249: 88-98.
Byrne JG, Karavas AN, Gudbjartson T, Leacche M, Rawn JD, Couper GS, Rizzo RJ, Cohn LH, Aranki SF. Left anterior descending coronary endarterectomy: early and late results in 196 consecutive patients. Ann Thorac Surg 2004; 78: 867-873.
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: 1691-1696.
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: 462-473.
Qiu Z, Chen X, Jiang Y, Wang LM, 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.
Sirivella S, Gielchinsky I, Parsonnet V. Results of coronary artery endarterectomy and coronary artery bypass grafting for diffuse coronary artery disease. Ann Thorac Surg 2005; 80: 1738-1744.
Nishigawa K, Fukui T, Yamazaki M, Takanashi S. Ten-year experience of coronary andarterectomy for the diffusely diseased left anterior descending artery. Ann Thorac Surg 2017; 103: 710-716.
Takahashi M, Gohil S, Tong B, Lento P, Filsoufi F, Reddy RC. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg 2013; 16: 301-305.
Takanashi S, Fukui T, Miyamoto Y. Coronary endarterectomy in the left anterior descending artery. J Cardiol 2008; 52: 261-268.
Nishi H, Miyamoto S, Takanashi S, Minamimura H, Ishikawa T, Kato Y, Shimizu Y. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg 2005; 79: 846-853.
Schmitto JD, Kolat P, Ortmann P, Popov AF, Coskun KO, Friedrich M, Sossalla S, Toischer K, Mokashi SA, Tirilomis T, Baryalei MM, Schoendube FA. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease. J Cardiothorac Surg 2009; 4: 52.
Brenowitz JB, Kayser KL, Johnson WD. Results of coronary artery endarterectomy and reconstruction. J Thorac Cardiovasc Surg 1988; 95: 1-10.
Silberman S, Dzigivker I, Merin O, Shpira N, Deeb M, Britran D. Does coronary endarterectomy increase the risk of coronary bypass? J Card Surg 2002; 17: 267-271.
Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, Rokkas CK, Swistel DG, Connery CP, Toumpoulis IK. Postoperative and long-term outcome of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting. Ann Thorac Surg 2010; 89: 1112-1118.
de Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, Carrasco-Garri-do P, Bueno H, Puente-Maestu L, Jimenez-Trujillo I, Alvaro-Meca A, Esteban-Hernandez J, de Andrés AL. Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001-2011). Int J Ostruct Pulmon Dis 2015; 10: 2285-2294.
Russo M, Nardi, P, Saitto G, Bovio E, Pellegrino A, Scafuri A, Ruvolo G. Single versus double antiplatelet therapy in patients undergoing coronary artery bypass grafting with coronary endarterectomy: mid-term results and clinical implications. Interact Cardiovasc Thorac Surg 2017; 24: 203-208.
Bomb R, Oliphant CS, Khouzam RN. Dual antiplatelet therapy after coronary artery bypass grafting in the setting of acute coronary syndrome. Am J Cardiol 2015; 116: 148-154.
de Leon N, Jackevicius CA. Use of aspirin and clopidogrel after coronary artery bypass graft surgery. Ann Pharmacother 2012; 46: 678-687.
Marinelli G, Chiappini B, Di Eusanio M, Di Bartolomeo R, Caldarera I, Marrozzini C, Marzocchi A, Pierangeli A. Bypass grafting with coronary endarterectomy: immediate and long-term results. J Thorac Cardiovasc Surg 2002; 124: 553-560.
Schwann TA, Zacharias A, Riordan CJ, Durham SJ, Shah AS, Habib RH. Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy: role of arterial versus vein conduits. Ann Thorac Surg 2007; 84: 25-31.
Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR Jr, Morel MA, Van Dyck N, Houle VM, Dawkins KD, Serruys PW. Coronary artery bypass surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary artery disease: 5-year follow up of the randomized clinical SYNTAX trial. Lancet 2014; 381: 629-638.
CASS Principal Investigators and Their Associates. Myocardial infarction and mortality in the coronary artery surgery study (CASS) randomized trial. N Engl J Med 1984; 310: 750-758.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe