Optimal method of coronary endarterectomy for diffusely diseased coronary arteries
Hiroyuki Nishi1, Satoru Miyamoto, Shuichiro Takanashi
1Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan. nishi24@jc4.so-net.ne.jp
Insights
Coronary endarterectomy (CE) with long arteriotomies and on-lay patch bypass grafting shows superior midterm patency rates compared to the conventional pull-out method in patients with diffuse coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) techniques incorporating coronary endarterectomy (CE) exist, but late patency data for different CE methods are limited.
- Assessing the quality of CE is crucial for improving outcomes in patients with diffusely diseased coronary arteries.
Purpose of the Study:
- To compare the clinical and angiographic outcomes of two distinct CE techniques in patients undergoing CABG.
- To evaluate the late patency rates and safety of CE methods for treating diffuse coronary artery disease.
Main Methods:
- A comparative study of 127 patients undergoing CABG with CE between 1994 and 2002.
- Group O (n=68): CE with long arteriotomies and on-lay patch bypass grafting.
- Group P (n=59): CE with the conventional pull-out method.
Main Results:
- Midterm angiographic follow-up (mean 21 months) showed significantly higher Grade A patency rates for Group O (76.1%) versus Group P (38.1%) (p < 0.001).
- Early patency rates were 92.1% (Grade A: 79.4%) for Group O and 88.6% (Grade A: 68.6%) for Group P.
- Five-year actuarial survival was 90.7% for Group O and 74.0% for Group P (p = 0.1).
Conclusions:
- Coronary endarterectomy using long arteriotomies and on-lay patch bypass grafting demonstrates superior midterm angiographic results compared to the conventional pull-out method.
- This technique is safe and effective for achieving complete revascularization in patients with severe, diffuse coronary artery disease.
Background:
Although several techniques for coronary artery bypass grafting have been introduced that incorporate coronary endarterectomy (CE), there is little information about late patency among the various CE methods. To clarify the quality of CE, we assessed clinical and angiographic results of our experience with this procedure on 127 patients who had diffusely diseased coronary arteries.
Methods:
Between January 1994 and December 2002, 127 patients underwent coronary artery bypass grafting with CE. Sixty-eight patients undergoing CE with long arteriotomies and on-lay patch bypass grafting (group O) were compared with 59 patients undergoing CE with the conventional pull-out method (group P).
Results:
Thirty-day mortality was 2.9% in group O and 6.8% in group P. The early angiographic results of 115 patients revealed a patency rate of 92.1% (grade A: 79.4%) in group O and 88.6% (grade A: 68.6%) in group P. Actuarial survival at 5 years was 90.7% in group O and 74.0% in group P (p = 0.1). Angiograms performed on 78 patients after a mean period of 21 +/- 16 months showed a patency rate of 89.1% (grade A:76.1%) in group O and 81.0% (grade A: 38.1%) in group P (grade A: p < 0.001).
Conclusions:
The midterm angiographic results of CE with long arteriotomies and on-lay patch bypass grafting were better than the results obtained with the conventional pull-out method. This procedure was found to be safe and effective for complete revascularization in patients with a severely and diffusely diseased coronary artery.
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