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Five-year follow-up after long plaque-bridging coronary arteriotomy for diffuse coronary artery disease
1Department of Thoracic- and Cardiovascular Surgery, J.W. Goethe University, Frankfurt am Main, Germany. mirkodoss@aol.com
Insights
Plaque-bridging arteriotomy offers comparable graft patency to conventional bypass surgery for diffuse coronary artery disease. This technique effectively treats complex arterial blockages, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Diffuse coronary artery disease presents challenges for surgical revascularization.
- Long arteriotomy bridging stenotic segments may enhance blood flow but raises concerns about graft patency.
- Vascular wall pathology in diseased segments can impact long-term graft survival.
Purpose of the Study:
- To compare graft patency rates between plaque-bridging arteriotomy and conventional coronary artery bypass grafting (CABG).
- To evaluate the efficacy of plaque-bridging arteriotomy in treating diffuse coronary artery disease.
Main Methods:
- Retrospective analysis of 104 patients (mean age 65 years) undergoing plaque-bridging arteriotomy (14-40 mm length) for diffuse coronary artery disease.
- Comparison of intra-individual bypass graft patency using multidetector-computed tomography or coronary angiography.
- Follow-up duration averaged 5 years.
Main Results:
- Internal thoracic artery (ITA) to left anterior descending artery (LAD) plaque-bridging patency was 94.8% (conventional 94.9%).
- Saphenous vein graft (SVG) patency for circumflex artery (CX) and right coronary artery (RCA) showed comparable rates between plaque-bridging and conventional methods (SVG-CX: 67% vs 72.4%; SVG-RCA: 79.5% vs 75%).
- High rates of freedom from angina (82.8%), myocardial infarction (95.7%), and reintervention (91.4%) were observed.
Conclusions:
- Extending arteriotomy over plaques is a viable treatment for diffuse coronary artery disease.
- Plaque-bridging arteriotomy demonstrates graft patency rates comparable to bypass grafts on less diseased segments.
- This approach offers comparable long-term clinical outcomes to conventional CABG.
Unlabelled:
Long arteriotomy bridging a stenotic plaque or segment may improve runoff in diffuse coronary artery disease. However, patency might be impaired due to vascular wall pathology.
Objective:
To determine the patency rates of plaque-bridging arteriotomy compared to conventional coronary artery bypass grafting.
Methods:
Between May 1995 and December 1998, 104 patients with a mean age of 65 +/- 7 years received a long arteriotomy extending over a heavily plaqued area in an effort to treat their diffuse coronary artery disease. The length of the arteriotomy ranged from 14 mm to 40 mm. We retrospectively analyzed the intra-individual bypass graft patency rates by multidetector-computed tomography or coronary angiography.
Results:
The mean follow-up was 5 years. There were 5 (4.8 %) early and 10 (9.6 %) late deaths, three non-cardiovascular. Graft patency for internal thoracic artery (ITA) to left anterior descending artery (LAD) (plaque-bridging) was 94.8 %, for saphenous vein graft (SVG) to circumflex artery (CX) (plaque-bridging) 67 %, and SVG to right coronary artery (RCA) (plaque-bridging) 79.5 %. Graft patency for ITA to LAD (conventional) was 94.9 %, for SVG to CX (conventional) 72.4 %, and SVG to RCA (conventional) 75 %. Freedom from angina was 82.8 % (n = 58/70), freedom from myocardial infarction was 95.7 % (n = 67/70), freedom from reintervention was 91.4 % (n = 64/70) and freedom from reoperation was 100 % (n = 70/70).
Conclusion:
Diffuse coronary artery disease can be treated by extending the arteriotomy over the plaques, with graft patency rates comparable to bypass grafts onto less diseased segments.
