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Long-term results after coronary artery reconstructive surgery
V Gegouskov1, U Tochtermann, D Badowski-Zyla
1Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. vassil.gegouskov@med.uni-heidelberg.de
Insights
Coronary reconstruction surgery for complex coronary artery disease demonstrates favorable long-term outcomes. This procedure shows satisfying graft patency, improved patient survival, and a low reintervention rate.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Diffuse coronary artery disease (CAD), multiple stenoses, and complex lesions are common in cardiac surgery.
- Coronary reconstructive surgery, including extended anastomoses and thromboendarterectomy, remains a topic of debate.
- Evaluating the long-term efficacy of coronary reconstruction is crucial for patient management.
Purpose of the Study:
- To assess the long-term results of coronary reconstructive surgery in patients with complex coronary morphology.
- To determine graft patency, survival rates, and functional outcomes (NYHA class) post-reconstruction.
- To analyze the reintervention rates following coronary reconstruction procedures.
Main Methods:
- A cohort of 640 patients undergoing isolated CABG with LAD coronary reconstruction was studied.
- Long-term follow-up was conducted over a period of up to 10 years, with a 99.2% completeness rate.
- Patient-reported outcomes were gathered via questionnaires, achieving an 83.2% response rate.
Main Results:
- Mortality was 22.9% over the 10-year follow-up.
- Of responders, 79.2% improved by at least one NYHA class, with 15.9% remaining unchanged.
- Reintervention rates were low: 0.8% for PCI and 0.5% for redo CABG.
Conclusions:
- Coronary reconstruction in complex CAD patients yields satisfying graft patency and excellent long-term survival.
- The procedure is associated with significant improvements in NYHA functional class.
- Low reintervention rates suggest the durability and effectiveness of coronary reconstruction.
Background:
Diffuse coronary artery disease, multiple consecutive stenoses and complex lesions are a common finding in coronary surgery. Coronary reconstructive surgery in terms of extended anastomoses with or without thromboendarterectomy is still controversially discussed. The aim of this study was to evaluate the long-term results of patients who underwent coronary reconstruction.
Methods:
Between January 1995 and June 2004, 640 consecutive, unselected patients underwent isolated CABG with coronary reconstructive surgery of the LAD at a single institution. A cross-sectional long-term follow-up was performed with a completeness of 99.2 %. Questionnaires were sent to all patients with a response rate of 83.2 % (n = 533).
Results:
147 of the 640 patients (22.9 %) died during up the follow-up period which was up to 10 years. Of the 371 patients who responded to the questionnaires, the status of 54 patients (15.9 %), predominantly those with a preoperative lower NYHA class, remained unchanged, while 294 patients (79.2 %) improved by at least one NYHA class. Repeat angiography was performed in 80 patients (15.7 %). Indications for percutaneous coronary intervention for the LAD arose in 4 cases (0.8 %); the interventions were performed in the proximal (n = 2) or distal (n = 1) LAD and one intervention affected the anastomotic area. Redo CABG was necessary in 3 patients (0.5 %).
Conclusions:
Coronary reconstruction in patients with complex coronary morphology and advanced diffuse CAD is in an additionally investigated subgroup of patients associated with a satisfying graft patency and excellent long-term results in terms of survival, NYHA class and reintervention rate.
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