Short-and Long-term Results of Coronary Artery Bypass Grafting with Coronary Endarterectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FANGQin ,  GUTian-xiang , LIUBo , SHIEn-yi , YULei , WANGChun

Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

GUTian-xiang, Email: cmugtx@sina.com

Keywords：

Coronary artery bypass grafting; Coronary endarterectomy; Diffuse coronary artery disease

DOI：

10.7507/1007-4848.20140214

Video：

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Objective To investigate surgical treatment strategies for diffuse coronary artery disease (CAD). Methods From January 2003 to June 2013, 92 patients with diffuse CAD received complete coronary revascularization including coronary artery bypass grafting (CABG)and coronary endarterectomy (CE)in the First Affiliated Hospital of China Medical University. There were 63 male and 29 female patients with their age of 52-81 (68.7±10.5)years. After CE and during follow-up, coronary CT angiography (CTA)was used to assess graft patency, and improvement of patients' cardiac function and angina symptoms were observed. Results Target vessel diameter of the 92 patients was all larger than 1.5 mm after CE. Sixty-three patients (with 69 CE grafts)received intraoperative graft blood flow measurement, showing 59 grafts (85.5%)with satisfactory blood flow[blood flow 13-42 (23.4±12.7)ml/min, pulsatility index (PI)1.6-4.2 (2.1±1.1)]. Six patients (6.5%)had perioperative myocardial infarction (MI), and 4 patients (4.3%)died within 30 days after surgery including 2 patients with acute MI and cardiogenic shock, 1 patient with low cardiac output syndrome and multiple organ failure, and 1 patient with massive cerebral infarction. Seventy-three patients (83%)were followed up for 6-108 (49.3±26.7)months after discharge, and 15 patients were lost during follow-up. During follow-up, coronary CTA showed graft patency of 83.9% after CE. Four patients (5.5%)died including 1 patient with heart failure and pulmonary infection, 1 patient of unexplained sudden death, 1 patient with cerebral hemorrhage, and 1 patient with lung cancer. Five-year survival rate was 87% after CE. Six months after CE, ejection fraction (EF)was significantly higher than preo-perative EF (55.6%±9.7% vs. 50.2%±10.5%, P < 0.05), patients' cardiac function significantly improved, and their angina symptoms were significantly relieved. Conclusion CABG with CE can improve coronary revascularization for patients with diffuse CAD, and short-and long-term results are satisfactory.

Citation： FANGQin, GUTian-xiang, LIUBo, SHIEn-yi, YULei, WANGChun. Short-and Long-term Results of Coronary Artery Bypass Grafting with Coronary Endarterectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 744-747. doi: 10.7507/1007-4848.20140214 Copy

1.	Nishi H, Miyamoto S, Takanashi S, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg, 2005, 79(3):846-852.
2.	Schwann TA, Zacharias A, Riordan CJ, et al. Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy:Role of arterial versus vein conduits. Ann Thorac Surg, 2007, 84(1):25-31.
3.	Resetar ME, Ullmann C, Broeske PA, et al. Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep. J Thorac Cardiovasc Surg, 2007, 133(5):1252-1256.
4.	Elbardissi AW, Balaguer JM, Byrne JG, et al. Surgical therapy for complex coronary artery disease. Semin Thorac Cardiovasc Surg, 2009, 21(3):199-206.
5.	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.
6.	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.
7.	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(3):301-305.
8.	刘畅, 肖喜刚, 王柏春, 等.冠状动脉旁路移植术后移植血管通畅率的影响因素分析.中国胸心血管外科临床杂志, 2012, 19(6):606-609.
9.	Myers PO, Tabata M, Shekar PS, et al. Extensive endarterectomy and reconstruction of the left anterior descending artery:early and late outcomes.J Thorac Cardiovasc Surg, 2012, 143(6):1336-1340.
10.	陈鑫, 徐明, 汪黎明, 等.非体外循环下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变.中华外科杂志, 2006, 44(14):940-942.
11.	Dawood MY, Lehr EJ, de Biasi A, et al. Robotically assisted coronary endarterectomy. Innovations(Phila), 2011, 6(6):391-394.
12.	Pleskovič A, Vraspir-Porenta O, Zorc-Pleskovič R, et al. Deficiency of mast cells in coronary artery endarterectomy of male patients with type 2 diabetes.Cardiovasc Diabetol, 2011, 10(1):40.
13.	Schmitto JD, Kolat P, Ortmann P, et al. Early results of coronary artery bypass grafting with coronary endarterectomy for severecoronary artery disease.J Cardiothorac Surg, 2009, 4(1):52.
14.	LaPar DJ, Anvari F, Irvine JN Jr, et al. The impact of coronary artery endarterectomy on outcomes during coronary artery bypass grafting. J Card Surg, 2011, 26(3):247-253.
15.	Uchimuro T, Fukui T, Mihara W, et al. Acute thrombosis after endarterectomy of stented left anterior descending artery. Interact Cardiovasc Thorac Surg, 2009, 8(6):663-665.
16.	Kumar S, Nair RU. Left anterior descending artery endarterectomy by hydrodissection. Heart Lung Circ, 2009, 18(4):289-292.
17.	Abid AR, Farogh A, Naqshband MS, et al. Hospital outcome of coronary artery bypass grafting and coronary endarterectomy. Asian Cardiovasc Thorac Ann, 2009, 17(1):59-63.
18.	Zamir AG, Iqbal A, Ahmad SA, et al. Coronary endarterectomy for severe diffuse coronary artery disease. J Coll Physicians Surg Pak, 2009, 19(6):338-341.
19.	Khalifa AA, Cornily JC, David CH, et al. Medium-term survival of diffuse coronary artery disease patients following coronary arteryreconstruction with the internal thoracic artery. Cardiology, 2011, 120(4):192-199.
20.	Livesay JJ, Cooley DA, Hallman GL, et al. Early and late results of coronary endarterectomy, analysis of 3369 patients. J Thorac Cardiovasc Surg, 1986, 92(4):649-660.
21.	Shapira OM, Akopian G, Hussain A, et al. Improved clinical outco-mes in patients undergoing coronary artery bypass grafting with coronary endarterectomy. Ann Thorac Surg, 1999, 68(6):2273-2278.
22.	Ariyaratnam P, Javangula K, Papaspyros S, et al. Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease. Eur J Cardiothorac Surg, 2012, 42(6):e140-e145.
23.	汪黎明, 陈鑫, 徐明, 等.弥漫性冠状动脉病变的外科治疗.中国胸心血管外科临床杂志, 2008, 15(5):333-335.
24.	Santini F, Casali G, Lusini M, et al. Mid-term results after extensive vein patch Reconstruction and internal mammary grafting of the diffusely diseased left anterior descending coronary artery. Eur J Cardiothorac Surg, 2002, 21(6):1020-1025.

1. Nishi H, Miyamoto S, Takanashi S, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg, 2005, 79(3):846-852.
2. Schwann TA, Zacharias A, Riordan CJ, et al. Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy:Role of arterial versus vein conduits. Ann Thorac Surg, 2007, 84(1):25-31.
3. Resetar ME, Ullmann C, Broeske PA, et al. Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep. J Thorac Cardiovasc Surg, 2007, 133(5):1252-1256.
4. Elbardissi AW, Balaguer JM, Byrne JG, et al. Surgical therapy for complex coronary artery disease. Semin Thorac Cardiovasc Surg, 2009, 21(3):199-206.
5. 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.
6. 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.
7. 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(3):301-305.
8. 刘畅, 肖喜刚, 王柏春, 等.冠状动脉旁路移植术后移植血管通畅率的影响因素分析.中国胸心血管外科临床杂志, 2012, 19(6):606-609.
9. Myers PO, Tabata M, Shekar PS, et al. Extensive endarterectomy and reconstruction of the left anterior descending artery:early and late outcomes.J Thorac Cardiovasc Surg, 2012, 143(6):1336-1340.
10. 陈鑫, 徐明, 汪黎明, 等.非体外循环下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变.中华外科杂志, 2006, 44(14):940-942.
11. Dawood MY, Lehr EJ, de Biasi A, et al. Robotically assisted coronary endarterectomy. Innovations(Phila), 2011, 6(6):391-394.
12. Pleskovič A, Vraspir-Porenta O, Zorc-Pleskovič R, et al. Deficiency of mast cells in coronary artery endarterectomy of male patients with type 2 diabetes.Cardiovasc Diabetol, 2011, 10(1):40.
13. Schmitto JD, Kolat P, Ortmann P, et al. Early results of coronary artery bypass grafting with coronary endarterectomy for severecoronary artery disease.J Cardiothorac Surg, 2009, 4(1):52.
14. LaPar DJ, Anvari F, Irvine JN Jr, et al. The impact of coronary artery endarterectomy on outcomes during coronary artery bypass grafting. J Card Surg, 2011, 26(3):247-253.
15. Uchimuro T, Fukui T, Mihara W, et al. Acute thrombosis after endarterectomy of stented left anterior descending artery. Interact Cardiovasc Thorac Surg, 2009, 8(6):663-665.
16. Kumar S, Nair RU. Left anterior descending artery endarterectomy by hydrodissection. Heart Lung Circ, 2009, 18(4):289-292.
17. Abid AR, Farogh A, Naqshband MS, et al. Hospital outcome of coronary artery bypass grafting and coronary endarterectomy. Asian Cardiovasc Thorac Ann, 2009, 17(1):59-63.
18. Zamir AG, Iqbal A, Ahmad SA, et al. Coronary endarterectomy for severe diffuse coronary artery disease. J Coll Physicians Surg Pak, 2009, 19(6):338-341.
19. Khalifa AA, Cornily JC, David CH, et al. Medium-term survival of diffuse coronary artery disease patients following coronary arteryreconstruction with the internal thoracic artery. Cardiology, 2011, 120(4):192-199.
20. Livesay JJ, Cooley DA, Hallman GL, et al. Early and late results of coronary endarterectomy, analysis of 3369 patients. J Thorac Cardiovasc Surg, 1986, 92(4):649-660.
21. Shapira OM, Akopian G, Hussain A, et al. Improved clinical outco-mes in patients undergoing coronary artery bypass grafting with coronary endarterectomy. Ann Thorac Surg, 1999, 68(6):2273-2278.
22. Ariyaratnam P, Javangula K, Papaspyros S, et al. Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease. Eur J Cardiothorac Surg, 2012, 42(6):e140-e145.
23. 汪黎明, 陈鑫, 徐明, 等.弥漫性冠状动脉病变的外科治疗.中国胸心血管外科临床杂志, 2008, 15(5):333-335.
24. Santini F, Casali G, Lusini M, et al. Mid-term results after extensive vein patch Reconstruction and internal mammary grafting of the diffusely diseased left anterior descending coronary artery. Eur J Cardiothorac Surg, 2002, 21(6):1020-1025.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-and Long-term Results of Coronary Artery Bypass Grafting with Coronary Endarterectomy

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