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Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu's Arteritis
Kwon Joong Na1, Kyung-Hak Lee, Se Jin Oh
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Insights
Off-pump coronary artery bypass grafting (CABG) in Takayasu's arteritis patients showed excellent early and mid-term graft patency. This anaortic technique avoids aortic manipulation, improving outcomes for this rare condition.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Vascular Medicine
Background:
- Takayasu's arteritis can affect coronary arteries, posing a fatal risk.
- Coronary artery bypass grafting (CABG) is a treatment option for affected patients.
- Evaluating surgical outcomes in this rare condition is crucial.
Purpose of the Study:
- To assess the early and mid-term results of CABG in patients with Takayasu's arteritis.
- To determine the efficacy and safety of anaortic off-pump CABG (OPCAB) in this patient group.
Main Methods:
- Retrospective analysis of 5 Takayasu's arteritis patients undergoing isolated CABG (1998-2012).
- All patients received anaortic off-pump CABG (OPCAB) using internal thoracic arteries (ITA).
- Perioperative and follow-up medical treatment for arteritis was administered as needed.
Main Results:
- No surgical mortality observed, with all patients discharged without complications.
- 100% graft patency at early postoperative angiography (12/12 distal anastomoses).
- 100% graft patency maintained at 1-year follow-up angiography (9/9 distal anastomoses).
Conclusions:
- Anaortic OPCAB effectively avoids complications from manipulating the aorta in Takayasu's arteritis.
- Excellent early and mid-term graft patency was achieved with OPCAB combined with medical management.
- This approach offers a safe and effective surgical strategy for coronary artery disease in Takayasu's arteritis.
Background:
Coronary involvement in Takayasu's arteritis is a rare but fatal disease. The aim of this study was to evaluate the early and mid-term results of Takayasu's arteritis patients who underwent coronary artery bypass grafting (CABG).
Materials And Methods:
Of 2,280 patients who underwent isolated CABG from January 1998 to June 2012, Takayasu's arteritis was identified in 5 patients. There were 3 female patients, and the mean age was 58±9 years. Takayasu's arteritis was diagnosed during preoperative evaluation for coronary artery disease in 4 patients, and the initial manifestation was angina pectoris in 4 patients. All of the patients underwent anaortic off-pump CABG (OPCAB) using the in situ left or right internal thoracic arteries (ITA); 3 patients had severe stenosis of the proximal left subclavian artery and the in situ right ITA was used instead. Medical treatment for inflammatory arteritis during the perioperative and follow-up period was performed if indicated. Early, 1-year, and 5-year angiographic results and clinical outcomes were analyzed.
Results:
There was no surgical mortality, and all of the patients were discharged without complications on postoperative 8±2 days. Early postoperative (postoperative 2±1 days) angiography demonstrated a graft patency of 100% (12 of 12 distal anastomoses). One-year (13±3 months) angiography was performed in 4 patients, and all of the grafts were patent (100%, 9 of 9 distal anastomoses).
Conclusion:
By performing anaortic OPCAB in patients with Takayasu's arteritis, we were able to avoid complications associated with manipulating an atherosclerotic and severely calcified ascending aorta. The early and mid-term graft patency of OPCAB in Takayasu's arteritis was maintained when concomitant with medical treatment.
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