Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu's Arteritis

Abstract

BackgroundCoronary 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 MethodsOf 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.ResultsThere 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).ConclusionBy 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.

Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis

“…Evidence supporting the surgical management of arterial stenosis in TAK arises from several retrospective case series (LoE 4), with variable baseline characteristics of the patients included, different involved vascular sites and variable concomitant medical treatment 76–108. Indications for referral, when specified, mainly comprised symptomatic arterial stenosis (eg, renovascular uncontrolled hypertension, transient ischaemic attack, limb claudication, syncope, vertigo, angina).…”

Hybrid Coronary Artery Revascularization for Takayasu Arteritis with Major Visceral Collateral Circulation from the Left Internal Thoracic Artery

“…Surgery is strongly recommended during the inactive phase of vasculitis because subsequent steroid treatment can lead to a significant regression of the coronary artery stenosis, resulting in the occlusion of bypass grafts from flow competition [2,4]. We performed total arterial revascularization considering the patient’s young age.…”

“…However, in the present case, both subclavian arteries were normal and the quality of the right ITA was excellent. Long-term patency is considered acceptable in coronary artery bypass grafting using an appropriate-quality ITA even in TA patients [2, 4]. As the available arterial grafts were limited in patients with TA, we adopted a hybrid approach (percutaneous intervention for the RCA with a drug-eluting balloon and OPCAB).…”

Three Vessel Disease with Left Main Involvement: A Rare Manifestation of Takayasu’s Arteritis

“…It was initially postulated that the use of saphenous vein grafts may be more beneficial in these patients due to a high restenosis rate for arterial grafts. [21] However Kwon Joong et al reported very good outcomes with OPCAB as well as use of in situ arterial grafts [22].…”