Coronary endarterectomy for severe diffuse coronary artery disease
Ali Gohar Zamir1, Afsheen Iqbal, Syed Afzal Ahmad
1Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Health Diseases, Rawalpindi. aligoharzamir488@hotmail.com
Insights
Coronary endarterectomy (CE) as an adjunct to coronary artery bypass graft (CABG) surgery offers acceptable risks for diffuse coronary artery disease. This procedure provides satisfactory one-year survival and significant angina relief for patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Diffuse coronary artery disease (CAD) poses challenges for conventional coronary artery bypass graft (CABG) surgery.
- Coronary endarterectomy (CE) is explored as an adjunct procedure for complex CAD cases.
- Evaluating the efficacy and safety of CE in conjunction with CABG is crucial for patient management.
Purpose of the Study:
- To assess the outcomes of Coronary Endarterectomy (CE) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery for diffuse Coronary Artery Disease (CAD).
- To evaluate postoperative mortality, morbidity, angina relief, and one-year survival rates following CE combined with CABG.
- To determine the feasibility of CE as an adjunct to CABG in complex diffuse CAD.
Main Methods:
- A case series study was conducted involving patients with diffuse CAD unsuitable for conventional bypass grafting.
- Exclusion criteria included akinetic myocardium, poor left ventricular function, severe hepatic or immune deficiency, and poor lung function.
- Cardiopulmonary Bypass (CPB) was utilized in all procedures, with a mean follow-up of one year for outcome assessment.
Main Results:
- Fifty-five patients underwent CE for severe diffuse CAD; 47.3% had prior myocardial infarction, and 29.1% had unstable angina.
- Early mortality was 3.6%, with 3.6% experiencing non-fatal infarctions and 5.4% developing low cardiac output postoperatively.
- At one-year follow-up, no late deaths were recorded, and 91.5% of patients reported significant angina relief (CCS class II/III).
Conclusions:
- Coronary Endarterectomy (CE) serves as a viable adjunct to Coronary Artery Bypass Graft (CABG) surgery for selected patients with diffuse CAD.
- The procedure demonstrated acceptable operative risks, including low early mortality and morbidity.
- Satisfactory one-year outcomes were observed, characterized by high survival rates and substantial improvement in angina symptoms.
Objective:
To determine the outcome of Coronary Endarterectomy (CE) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery for diffuse Coronary Artery Disease (CAD), in terms of postoperative mortality and morbidity, relief from angina and survival at one year.
Study Design:
A case series.
Place And Duration Of Study:
Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2003 to November 2005.
Methodology:
Included in the study were all patients with such diffuse CAD that conventional bypass grafting was not possible. Those with the diseased coronary artery supplying an akinetic myocardium and a fixed perfusion defect on perfusion scan, or with poor left ventricular function (ejection fraction<30%) in association with severe chronic hepatic disease and deranged liver function tests, permanent severe immune deficiency state, or poor results at lung function tests were excluded. Cardiopulmonary Bypass (CPB) was used in all patients. All patients were followed up for a mean time of one year, for assessment of postoperative mortality and morbidity, relief from angina and survival.
Results:
Fifty five patients (3.2%) underwent CE of at least one major coronary artery for severe diffuse atheromatous disease. The mean age was 53.9+/-9.5 years. Twenty six (47.3%) had previous Myocardial Infarction (MI), 16 (29.1%) had unstable angina, 12 (21.8%) had poor Left Ventricular (LV) function, 5 (9.1%) underwent emergency CABG surgery for impending infarction, 39 (70.9%) had angina Canadian Cardiovascular Society (CCS) class II/III, 11 (20%) had critical left main stem disease and 12 (21.8%) required Intra-Aortic Balloon Pump (IABP) for hemodynamic support. There were 2 (3.6%) early deaths and 2 (3.6%) cases of non-fatal infarctions. Three (5.4%) patients had low Cardiac Output (CO) after operation. At one year follow-up, there were no late deaths and 43 patients (91.5% of those reporting for follow-up) did not have angina.
Conclusion:
CE acted as an adjunct to CABG surgery with acceptable operative risks and satisfactory results at one year in terms of mortality and angina relief.
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