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Published on: May 14, 2013
Previous Stenting Doesn't Affect Outcome of Extensive Endarterectomy for Diffuse Coronary Artery Total Occlusions: A
Hamdy Singab1, Gamal Sami1,2
1Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Coronary endarterectomy (CE) with CABG is effective for total coronary artery occlusions (CTOs), even with prior stenting. This surgical technique shows comparable outcomes in graft patency and patient survival, supporting its use in complex CTO cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Extensive diffuse coronary artery total occlusions (CTOs) present significant surgical challenges.
- Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is a potential revascularization strategy for CTOs.
- The impact of prior stenting on the outcomes of CE for CTOs remains unclear.
Purpose of the Study:
- To evaluate the outcomes of left anterior descending artery (LAD) endarterectomy for CTO.
- To determine the influence of previous stenting on the success of LAD endarterectomy in CTO patients.
Main Methods:
- A retrospective study of 194 patients undergoing LAD endarterectomy for CTO.
- Propensity score matching was employed to balance patient groups (66 with prior stents, 128 without).
- Follow-up averaged 74 months, assessing LAD graft patency, graft and patient survival, and complications.
Main Results:
- No significant differences were observed in LAD graft patency between patients with and without prior stents (93.9% vs. 89.1%, P = .27).
- Graft survival (134.3 vs. 135.2 months) and patient survival (93.9% vs. 91.4%) were comparable between groups.
- No significant differences were found in patient survival time (132.3 vs. 138.0 months, P = .75).
Conclusions:
- Coronary endarterectomy (CE) serves as a valuable adjuvant technique to CABG for treating total coronary artery occlusions (CTOs).
- Prior stenting does not appear to negatively impact the outcomes of CE for LAD CTOs.
- CE combined with CABG offers a viable solution for complex CTOs, irrespective of prior interventions.
Background And Aim:
Extensive diffuse coronary artery total occlusions (CTOs) constitute a challenging surgical problem. Extensive coronary endarterectomy (CE) combined with CABG was suggested as a revascularization technique. It was claimed that previous stenting may affect outcome. The present study aimed to report the outcome of LAD endarterectomy for CTO and to determine the effect of previous stenting on this outcome.
Patients And Methods:
The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay, and mortality.
Results:
Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9% versus 89.1%; P = .27), graft survival (median [95% CI]: 134.3 months [127.0-141.5] versus 135.2 months [128.4-142.0]; P = .35), patients' survival (93.9% versus 91.4%) and patients' survival time (median [95% CI]: 132.3 months [125.0-139.5] versus 138.0 months [132.0-144.1]; P = .75].
Conclusion:
The present study supports using CE as an adjuvant technique with CABG in patients with TCOs. Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay and mortality. Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9 % versus 89.1; p=0.27), graft survival [median (95% CI): 134.3 months (127.0-141.5) versus 135.2 months (128.4-142.0); p=0.35], patients' survival (93.9 % versus 91.4 %) and patients' survival time [median (95% CI): (132.3 months (125.0-139.5) versus 138.0 months (132.0-144.1); p= 0.75]. Conclusions: The present study supports use CE as an adjuvant technique with CABG in patients with TCOs.
