Vol 24, No 3 (2017)
Original articles — Interventional cardiology
Published online: 2017-03-09

open access

Page views 1591
Article views/downloads 1378
Get Citation

Connect on Social Media

Connect on Social Media

Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques

Jae Hang Lee1, Cheong Lim2, Jun Sung Kim2, Kay-Hyun Park2
Pubmed: 28281737
Cardiol J 2017;24(3):242-249.

Abstract

Background: Coronary endarterectomy (CE) may be a good option for complete revascularization of diffuse coronary artery diseases, but it has not been widely used because the outcomes have not been definitively identified. This study aims to evaluate the mid-term clinical results of CE and compare the outcomes according to the use of cardiopulmonary bypass (CPB) and the surgical technique used.

Methods: Between 2004 and 2014, 69 cases of CE were performed in 64 patients. We divided the pa­tients into two groups: 1) on-pump coronary artery bypass with coronary endarterectomy (ONCAB-CE) versus off-pump coronary artery bypass with coronary endarterectomy (OPCAB-CE), and 2) “open” versus “closed” surgical techniques. Operative mortality and major morbidity, were investigated includ­ing perioperative myocardial infarction (PMI), and overall survival.

Results: Operative mortality was 4.7% (3/64), and no PMI was observed in the study. No statistical differences in operative mortality rate between the ONCAB-CE and OPCAB-CE groups were found (3.1% vs. 6.2%, p = 1.0) or between open versus closed techniques (6.7% vs. 2.9%, p = 0.6). The incidence of major morbidity including cerebrovascular accident, atrial fibrillation, acute renal failure, mediastinitis, respiratory complications, and bleeding was comparable between all groups. There were seven late mortalities, and no differences were found in overall survival rate between all groups.

Conclusions: Coronary endarterectomy appears to be a safe option for patients with diffuse coronary artery disease, regardless of whether CPB or a specified selection of surgical techniques are used.

Article available in PDF format

View PDF Download PDF file

References

  1. Williams DO, Holubkov R, Yeh W, et al. Percutaneous coronary intervention in the current era compared with 1985-1986: the National Heart, Lung, and Blood Institute Registries. Circulation. 2000; 102(24): 2945–2951.
  2. Sundt TM, Camillo CJ, Mendeloff EN, et al. Reappraisal of coronary endarterectomy for the treatment of diffuse coronary artery disease. Ann Thorac Surg. 1999; 68(4): 1272–1277.
  3. Bailey CP, May A, Lemmon WM. Survival after coronary endarterectomy in man. J Am Med Assoc. 1957; 164(6): 641–646.
  4. Marinelli G, Chiappini B, Di Eusanio M, et al. Bypass grafting with coronary endarterectomy: immediate and long-term results. J Thorac Cardiovasc Surg. 2002; 124(3): 553–560.
  5. Byrne JG, Karavas AN, Gudbjartson T, et al. Left anterior descending coronary endarterectomy: early and late results in 196 consecutive patients. Ann Thorac Surg. 2004; 78(3): 867–73; discussion 873.
  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(4): 649–660.
  7. Minale C, Nikol S, Zander M, et al. Controversial aspects of coronary endarterectomy. Ann Thorac Surg. 1989; 48(2): 235–241.
  8. Lawrie GM, Morris GC, 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(4): 717–723.
  9. Schaff HV, Gersh BJ, Pluth JR, et al. Survival and functional status after coronary artery bypass grafting: results 10 to 12years after surgery in 500 patients. Circulation. 1983; 68: 200–4.
  10. Brenowitz JB, Kayser KL, Johnson WD. Results of coronary artery endarterectomy and reconstruction. J Thorac Cardiovasc Surg. 1988; 95(1): 1–10.
  11. Wallsh E, Franzone AJ, Clauss RH, et al. Manual coronary endarterectomy with saphenous bypass: experience with 263 patients. Ann Thorac Surg. 1981; 32(5): 451–457.
  12. Hochberg MS, Merrill WH, Michaelis LL, et al. Results of combined coronary endarterectomy and coronary bypass for diffuse coronary artery disease. J Thorac Cardiovasc Surg. 1978; 75(1): 38–46.
  13. 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(5): 1738–1744.
  14. Nishi H, Miyamoto S, Takanashi S, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg. 2005; 79(3): 846–52; discussion 852.
  15. Vohra HA, Kanwar R, Khan T, et al. 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(5): 1691–1696.
  16. Eryilmaz S, Inan MB, Eren NT, et al. Coronary endarterectomy with off-pump coronary artery bypass surgery. Ann Thorac Surg. 2003; 75(3): 865–869.
  17. Kunt AS, Darcin OT, Demirbag R, et al. 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(3): E124–E128.
  18. Naseri E, Sevinç M, Erk MK. Comparison of off-pump and conventional coronary endarterectomy. Heart Surg Forum. 2003; 6(4): 216–219.
  19. Takanashi S, Fukui T, Miyamoto Y. Coronary endarterectomy in the left anterior descending artery. J Cardiol. 2008; 52(3): 261–268.
  20. Fukui T, Takanashi S, Hosoda Y. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg. 2005; 80(6): 2098–2105.