Coronary endarterectomy in patients with diffuse coronary artery disease: assessment of graft patency with computed tomography angiography

Abstract

Background: With a growing population of patients with advanced coronary artery disease (CAD), many of whom have undergone prior percutaneous coronary inter ventions, coronary endarterectomy (CE) allows for the extension of revascularization in patients with otherwise limited options. Whether adjunctive CE associated with standard surgery, combined with contemporary antiplatelet therapy, improves out comes remains largely unknown. Methods:We studied 147 consecutive patients who underwent 154 adjunctive CE procedures for advanced CAD between January 2015 and January 2018. We used computed tomography angiography (CTA) in a subgroup of 32 consecutive patients who underwent CE during coronary artery bypass grafting after June 2016 to assess graft and coronary patency.Results: Patients (mean age 67 ± SD 10 yr) underwent CE of the right (102 patients), the left anterior descending (LAD, 22 patients) and the circumflex (17 patients) cor onary arteries. Seven patients (5%) experienced a procedural myocardial infarction and there were no perioperative deaths. Among the 32 patients who underwent CTA 3 months after surgery, the mean patency of the endarterectomized coronary arteries and bypass grafts was 90% and 88%, respectively. All 6 arterial grafts on the LAD artery were patent. The mean survival rate and the mean rate of freedom from major adverse cardiovascular events was 95% ± 2% and 95% ± 6%, respectively. The patency rate was 100 % for patients evaluated at 3year follow up. Conclusion:Coronary endarterectomy offers a surgical option for patients with dif fuse CAD who may be unsuitable for coronary bypass alone. Grafts and endarter ectomized coronary artery patency remain adequate and explain the excellent patient survival and the freedom rate from major adverse cardiovascular events. Contexte : Avec une population croissante de patients atteints de coronaropathie avancée (CA), dont plusieurs ont déjà subi des interventions coronariennes percu tanées, l'endartériectomie coronarienne (EC) permet d'améliorer la revascularisation chez les patients pour qui les options sont par ailleurs limitées. On ignore si l'EC d'appoint associée à la chirurgie standard et alliée au traitement antiplaquettaire moderne permet d'améliorer les résultats.Méthodes : Nous avons étudié 147 patients consécutifs qui ont subi 154 EC d'appoint pour une coronaropathie avancée entre janvier 2015 et janvier 2018. Nous avons utilisé la coronarographie chez un sousgroupe de 32 patients consécutifs sou mis à une EC durant un pontage aortocoronarien après juin 2016 pour évaluer la per méabilité du greffon et des coronaires.Résultats : Les patients (âge moyen 67 ans ± écarttype [ÉT] 10 ans) ont subi une EC de la coronaire droite (102 patients), de la descendante antérieure gauche (22 patients) et de la circonflexe (17 patients). Sept patients (5 %) ont subi un infarctus du myocarde durant l'intervention et on n'a déploré aucun décès périopératoire. Parmi les 32 patients qui ont subi une coronarographie 3 mois après la chirurgie, la permé abilité moyenn...

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