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Published on: June 28, 2019
[Multiple coronary endarteriectomy in patients with diffusial coronary disease]
Insights
Multiple endarterectomies alongside coronary artery bypass grafting (CABG) can achieve complete revascularization in diffuse coronary artery disease (CAD). Despite complexity, outcomes are comparable to standard CABG, offering a solution for challenging cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Context:
- Patient profiles with coronary artery disease (CAD) are evolving, frequently involving prior interventions.
- Diffuse CAD necessitates advanced revascularization strategies beyond standard bypass grafting.
Purpose:
- To evaluate the efficacy and safety of multiple coronary endarterectomies (CE) as an adjunct to coronary artery bypass grafting (CABG).
- To assess the impact of CE on complete revascularization rates and long-term survival in complex CAD patients.
Summary:
- A study compared 88 patients undergoing CABG with multiple CE to 967 patients undergoing CABG alone.
- While CE involved significant portions of the right coronary artery (RCA) and left anterior descending (LAD) artery, operative mortality and morbidity were similar between groups.
- Five-year survival was 69% in the CE group versus 84% in the control group.
Impact:
- Multiple CE combined with CABG can achieve complete revascularization in approximately 10% of patients with diffuse atherosclerosis.
- This technique offers a viable option for complex CAD cases, although careful consideration of perioperative risks is warranted.
Unlabelled:
In recent years the profile of patients with CAD is continuously changing, often with previous operation or stenting. Multiple coronary endarterectomies have been utilized as an adjunct to CABG in this select group of patients to achieve complete revascularization because of the diffuse CAD.
Methods:
Between January 1997 and December 2001 eighty eight consecutive patients undergoing first time CABG with more than two CE were compared with a control group of 967 patients undergoing CABG without CE.
Results:
More than 9% of the CABG patients need two or more endarterectomies, with involvement of the RCA in 96% and LAD in 59%. The extended time of aortic clamping and the higher rate of perioperative MI lead to higher mortality in Group 1 without significant difference between groups. The 5 years survival was 69% in Group 1 and 84% in Group 2.
Conclusions:
The operative results--mortality and morbidity, are similar in both groups instead of the highest complexity of the procedures with multiple endarterectomies. The use of this method together with CABG allows complete revascularization in 10% of the operated patients with diffuse atherosclerosis.
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