Coronary Endarterectomy: Impact on Morbidity and Mortality When Combined With Coronary Artery Bypass Surgery

Tiruvoipati, Ravindranath; Loubani, Mahmoud; Lencioni, Mauro; Ghosh, Shilajit; Jones, Peter W.; Patel, Ramesh

doi:10.1016/j.athoracsur.2004.12.041

Cited by 48 publications

(49 citation statements)

References 26 publications

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“…However, recent studies arrived at different conclusions. A study suggested that the rate of mortality of patients who underwent CABG combined with CE was significantly higher than those who were treated by CABG or CE alone (9). The fact that patients who require CE treatment are commonly at a higher risk of perioperative MI and death may contribute to the higher rates of morbidity and mortality associated with CE (2).…”

Section: Discussionmentioning

confidence: 99%

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy

Wang

et al. 2017

Experimental and Therapeutic Medicine

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Effective therapies for preventing perioperative complications such as thrombosis and inflammation after coronary endarterectomy (CE) are lacking. Electrocoagulation electrotomes have been routinely used in surgery for their cutting, clotting, and hemostatic properties. As strong flattening tools, their electrocautery function may prevent mechanical intimal-adventitial injury to arterial circulation and attenuate stenosis. The present study investigated the effects of intravascular application of electrocautery on ameliorating inflammation and thrombosis in a rabbit model of abdominal aortic endarterectomy. New Zealand rabbits were randomly divided into the sham, control (endarterectomy), and study (endarterectomy + electrocautery) groups with 10 in each group. Abdominal aortas were partially blocked and intima was removed. Electrocautery was performed with an electrocoagulation electrotome through the entire blocked vessel lumen. Vascular ultrasound parameters, molecular biological and histological characteristics of the abdominal aorta including vascular diameter, blood flow velocity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and apoptosis rate of vascular endothelial cells (ECs) were evaluated postoperatively by vascular Doppler ultrasound, ELISA, real-time RT-PCR, flow cytometry, and immunofluorescence at various time points. Compared with the endarterectomy + electrocautery group, the isolated endarterectomy group had significantly increased levels and gene expression of TNF-α and IL-6 (P<0.05), and rates of apoptosis of vascular ECs (P<0.05), with gradual vascular stenosis and decreased blood flow velocity. In conclusion, intravascular application of electrocautery has favorable short-term effects on the abdominal aorta and can reduce inflammation in a rabbit model of abdominal aorta endarterectomy. Long-term anti-inflammatory and anti-thrombotic effects on arterial remodeling and the clinical value of electrocautery in CE remain to be determined.

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Section: Discussionmentioning

confidence: 99%

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy

Wang

et al. 2017

Experimental and Therapeutic Medicine

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“…Since Bailey's first coronary endarterectomy in the late 50's [6], the procedure has been the only weapon of the cardiac surgeons in these difficult cases for a long period. Despite the facts that higher rates of morbidity and mortality associated with the procedure [7,8], the coronary endarterectomy still keeps its place in these cases with improved results [5]. …”

Section: Discussionmentioning

confidence: 99%

“…Although, endarterectomy is another option in such cases, we also believe that sequential LITA grafting to be a less invasive, safe and a more effective procedure in every possible patients, when compared to endarterectomy with its morbidity and mortality rates reaching significant differences in some reports especially when performed on the LAD [4,7,14]. …”

Section: Discussionmentioning

confidence: 99%

Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

Mert

Çetin

Yıldız

et al. 2010

J Cardiothorac Surg

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PurposeSeveral alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study.Patients and MethodsIn order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months.ResultsSeventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%).ConclusionWe strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.

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“…In literature; higher percentage of left ventricular dysfunctions in patients with endarterectomy as seen in our study or similar ventricular functions in patients with or without endarterectomy have been reported. 1,3,7,9,10 Although the patients with left ventricle dysfunction was higher in the Group-1, low mortality rates were seen in both groups. As taken into consider the high percentage of women patients and diabetes for both groups, which were well-known two preoperative risk factors, this result is thought to be related to the myocardial protection provided by the application of retrograde blood cardioplegia besides the effectiveness of endarterectomy.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature the early mortality rates after coronary endarterectomy has been reported as 2.8-6%, which is similar to the present study results. [1][2][3][4][5][6][7]9 Open endarterectomy and long-segment anastomosis were preferred in all cases of the Group-1. Use of both close and open endarterectomy technique in the same series successfully has been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Isolated Coronary Artery Bypass Grafting with Open Coronary Endarterectomy Followed by Coronary Artery Revascularization

Toker¹,

Özbek²,

Çelik³

et al. 2017

Turkiye Klinikleri J Cardiovasc Sci

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Coronary Endarterectomy: Impact on Morbidity and Mortality When Combined With Coronary Artery Bypass Surgery

Cited by 48 publications

References 26 publications

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy

Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

Comparison of Isolated Coronary Artery Bypass Grafting with Open Coronary Endarterectomy Followed by Coronary Artery Revascularization

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