Long-term results after coronary artery reconstructive surgery.

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.