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Safety and feasibility of minimally invasive coronary artery bypass surgery early after drug eluting stent implantation due to acute coronary syndrome
Affiliations- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
open access
Abstract
Background: The evidence of performing minimally invasive coronary artery surgery early after drug eluting stent (DES) implantation due to acute coronary syndrome (ACS) is limited.
Aim: The aim of the study is to determine the safety and feasibility of this approach.
Methods: This registry includes 115 (78% male) patients from 2013‒2018, who underwent non-LAD percutaneous coronary intervention (PCI) due to ACS with contemporary DES implantation (39% diagnosed with myocardial infarction at baseline), followed by endoscopic atraumatic coronary artery bypass (EACAB) surgery within 180 days, after temporary P2Y12 inhibitor discontinuation. Primary composite endpoint of MACCE (Major Adverse Cardiac and Cerebrovascular Events), defined as death, myocardial infarction (MI), cerebrovascular incident and repeat revascularization was evaluated in long- term follow-up. The follow-up was collected via telephone survey and with National Registry for Cardiac Surgery Procedures.
Results: Median (interquartile range [IQR]) time interval separating both procedures was 100.0 (62.0‒136.0) days. Median (IQR) follow-up duration was 1338.5 (753.0‒2093.0) days and was completed from all patients with regard to mortality. Eight patients (7%) died; 2 (1.7%) had a stroke; 6 (5.2%) suffered from MI and 12 (10.4%) required repeat revascularization. Overall, the incidence of MACCE was 20 (17.4%).
Conclusions: EACAB is a safe and feasible method of LAD revascularization in patients who received DES for ACS within 180 days prior to surgery, despite early dual antiplatelet therapy discontinuation. The adverse event rate is low and acceptable.
Abstract
Background: The evidence of performing minimally invasive coronary artery surgery early after drug eluting stent (DES) implantation due to acute coronary syndrome (ACS) is limited.
Aim: The aim of the study is to determine the safety and feasibility of this approach.
Methods: This registry includes 115 (78% male) patients from 2013‒2018, who underwent non-LAD percutaneous coronary intervention (PCI) due to ACS with contemporary DES implantation (39% diagnosed with myocardial infarction at baseline), followed by endoscopic atraumatic coronary artery bypass (EACAB) surgery within 180 days, after temporary P2Y12 inhibitor discontinuation. Primary composite endpoint of MACCE (Major Adverse Cardiac and Cerebrovascular Events), defined as death, myocardial infarction (MI), cerebrovascular incident and repeat revascularization was evaluated in long- term follow-up. The follow-up was collected via telephone survey and with National Registry for Cardiac Surgery Procedures.
Results: Median (interquartile range [IQR]) time interval separating both procedures was 100.0 (62.0‒136.0) days. Median (IQR) follow-up duration was 1338.5 (753.0‒2093.0) days and was completed from all patients with regard to mortality. Eight patients (7%) died; 2 (1.7%) had a stroke; 6 (5.2%) suffered from MI and 12 (10.4%) required repeat revascularization. Overall, the incidence of MACCE was 20 (17.4%).
Conclusions: EACAB is a safe and feasible method of LAD revascularization in patients who received DES for ACS within 180 days prior to surgery, despite early dual antiplatelet therapy discontinuation. The adverse event rate is low and acceptable.
Keywords
EACAB; MIDCAB; antiplatelet; hybrid; acute coronary syndrome
About this articleTitle
Safety and feasibility of minimally invasive coronary artery bypass surgery early after drug eluting stent implantation due to acute coronary syndrome
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
Article type
Original article
Published online
2023-03-09
Page views
60
Article views/downloads
47
DOI
10.33963/KP.a2023.0066
Pubmed
Keywords
EACAB
MIDCAB
antiplatelet
hybrid
acute coronary syndrome
Authors
Krzysztof Sanetra
Piotr P Buszman
Piotr P Buszman
Justyna Jankowska-Sanetra
Justyna Jankowska-Sanetra
Marta Konopko
Marta Konopko
Monika Slabon-Turska
Monika Slabon-Turska
Krzysztof Białek
Krzysztof Białek
Krzysztof Milewski
Krzysztof Milewski
Witold Gerber
Witold Gerber
Andrzej Bochenek
Andrzej Bochenek
Mateusz Kachel
Mateusz Kachel
Paweł Kaźmierczak
Paweł Kaźmierczak
Paweł E Buszman
Paweł E Buszman
Marek Cisowski
Marek Cisowski
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