Early and late results of coronary endarterectomy

Jj, Livesay; Da, Cooley; Gl, Hallman; Gj, Reul; Da, Ott; Jm, Duncan; Oh, Frazier

doi:10.1016/s0022-5223(19)35867-2

Cited by 120 publications

(22 citation statements)

References 29 publications

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“…There is a wide variation in the reported results of endarterectomy in conjunction with CABG, most showing less favorable results, especially after endarterectomy to the LAD.4-6 Operative mortality rates range from 0% to lo%, perioperative MI rates range from 5 % to 30%, and patency rates range from 38% to l OO%, with 74% to 95% of patients being asymptomatic. [21][22][23][24][25][26][27][28] This wide discrepancy in clinical outcome is partly explained by different patient selection criteria, myocardial protection methods, and surgical techniques. A randomized controlled trial is required to clearly discern which patients benefit the most from endarterectomy, but this kind of study probably will never be performed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results of Endarterectomy of the Right and Left Anterior Descending Coronary Arteries

et al. 1985

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In this study, w e examined the clinical outcome of coronary endarterectomy. From 1990 t o 1998, 4839 patients underwent surgical revascularization. Coronary artery bypass graft surgery (CABG) was performed alone on 4516 patients, was combined with right coronary artery endarterectomy (RCA-E) in 242 patients, and was combined with left anterior descending coronary artery endarterectomy (LAD-E) in 81 patients. An analysis of preoperative variables revealed a higher proportion of males (90.79' 0 vs 80.2%, p < 0.001), of patients with low ejection fraction (< 35%; 4.69' 0 vs 1.796, p < 0.001), and of three-vessel disease (47.9% vs 3696, p < 0.001) in the RCA-E versus the CABG patients. There was a higher proportion of unstable angina (51.9% vs 40.3%, p = 0.04) in the LAD-E patients. The 30-day mortality rate for CABG was 2% versus 2.5% for RCA-E and 3.7% for LAD-E (p = NS). Perioperative myocardial infarction (MI) rate for CABG was 3.49/0 versus 7.00/0 for RCA-E (p < 0.001) and 4.996 for LAD-E patients (p = NS). Postoperative l o w cardiac output syndrome was recorded in 11.596 of CABG, 18.6% of RCA-E (p = O.Ol), and 11.1 YO of LAD-E (p = NS) patients. Predictors of postoperative bad outcome (death, MI, low cardiac output, cerebrovascular accident) were preoperative intra-aortic balloon pump, repeat operation, ejection fraction of < 350/, renal insufficiency, female gender, RCA-E, and age over 70. Protective factors included the use of internal mammary artery, multiple arterial grafts, and warm cardioplegia. Actuarial analysis at 6,12, and 24 months showed late mortality rates of 0.8%, 1.3%, and 2.19' 0 for CABG; 1.2%, 3.7%, and 3.7% for RCA-E; and 2.9%, 2.996, and 2.9% for LAD-E, respectively. Late MI occurrence was 0.4%. 0.49/0, and 0.7% for CABG; 1.5%, 1.5%. and 2.7% for RCA-E; and 0% for LAD-E, respectively. Multivariate analysis found renal insufficiency, ejection fraction of < 3556, repeat operation, female gender, New York Heart Association functional class IV, and diabetes to be predictors for late adverse events (recurrence of angina, MI, and cardiac death), and RCA-E was found to be a predictor of late MI. We conclude that the use of coronary endarterectomy to achieve complete revascularization in patients with diffuse distal coronary artery disease is a reasonable option, associated with a minimal addition in complication rates. (J Card Surg 1999;14: 16-25) In most patients undergoing coronary artery by-Address for correspondence: Bernard S. Goldrnan, M.D., Dipass graft surgery (CABG), a discrete or segmenvision of Cardiovascular Surgery, Sunnybrook Health Science Center, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5 tal proximal coronary Canada. Fax: 001-416-4806072. quately treated by bypass to the relatively *These two authors contributed equally to the article. nondiseased distal portion of the vessel. Several can be J CARD SURG 1999;14:16-25 ABRAHAMOV, ET AL. 17 ENDARTERECTOMY OF RIGHT AND LEFT ANTERIOR DESCENDING CORONARY ARTERIES

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Section: Discussionmentioning

confidence: 99%

Clinical Results of Endarterectomy of the Right and Left Anterior Descending Coronary Arteries

et al. 1985

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“…The limitations of the present clinical study are as follows: (1) the number of patients was small, (2) we only had CFVR data in 8 patients, (3) we did not carry out long-term clinical follow-up, and (4) this was a retrospective observational study and not randomized.…”

Section: Study Limitationsmentioning

confidence: 99%

“…Coronary endarterectomy has been used to treat severely or diffusely diseased coronary arteries since the 1950s [1]. However, early experiences of this method were not associated with satisfactory clinical results [2][3][4]. More recently, the benefits of endarterectomy for the left anterior descending artery (LAD) have gradually become recognized because surgical techniques and technologies have evolved [5,6].…”

Section: Introductionmentioning

confidence: 99%

Coronary endarterectomy in the left anterior descending artery

Takanashi

Fukui

Miyamoto

2008

Journal of Cardiology

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“…Medical treatment is the best way to avoid this sequence of events. Livesay et al [21] and Chesebro et al [22] recommended the use of acetylsalicylic acid and dipyridamol postoperatively, whereas Ferraris et al [14] prescribed the use of warfarin for three months after the surgery. Gill et al [23] recommended another treatment option in which intravenous heparin was infused for the first 48 hours postoperatively, which was then followed by the use of thienopyridine derivatives (ticlopidine and clopidogrel).…”

Section: Discussionmentioning

confidence: 99%

The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting

Yener¹,

Kervan²,

Korkmaz³

et al. 2014

Turk Gogus Kalp Dama

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Bu çalışmada, koroner endarterektominin (KE) eşzamanlı koroner arter baypas greftleme (KABG) geçiren hastalarda morbidite ve mortalite üzerindeki etkisi araştırıldı. Ça lış ma pla nı: Mart 2000 ve Nisan 2010 tarihleri arasında KABG cerrahisi ile beraber eşzamanlı KE ve yama plasti geçiren 587 hasta (KABG+KE grup) retrospektif olarak inceledi. Hastalar randomize bir şekilde seçilmiş ve aynı dönemde KE olmadan KABG cerrahisi geçirmiş 600 hasta (KABG grup) ile karşılaştırıldı. Hasta dosyalarından edinilen büyük parametre serileri ve alt grup analizi ile grupların kapsamlı bir değerlendirmesi yapıldı. Bul gu lar: KABG+KE grubundaki hastalar, KABG grubundakilerden daha yaşlıydı (59.6±10.3'e kıyasla 61.3±7.3; p<0.001). Aterosklerotik risk faktörleri insidansı, üç damar hastalığı ve kararsız angina pektoris şikayetleri KABG+KE grubunda biraz daha yüksekti (p<0.05). Eşzamanlı KE, kros klemp ve kardiyopulmoner baypas süresini uzattı. Ayrıca, ameliyat sonrası toplam entübasyon süresi (12±10.3'e kıyasla 12±7.4 saat; p<0.05) anlamlı şekilde daha uzundu (p<0.05). Miyokard enfarktüsü (p= 0.006) ve intraaortik balon pompası gerekliliği (p<0.001) oranları KABG+KE grubunda anlamlı olarak daha yüksekti. Mortalite oranı iki grup arasında farklı değildi. So nuç: Endarterektomi endikasyonu sınırlayıcı bir şekilde ele alınmaya devam edilmelidir. Endarterektomi, anastomozun teknik olarak mümkün görünmediği, sadece tıkanmış, yarı tıkanmış veya ciddi bir şekilde kalsifiye olmuş damarlarda uzun süreli stenoz ile uygulanmalıdır. Endarterektomi, KABG'nin yerine kullanılmamalı ve deneyimli bir cerrahi ekibi tarafından uygulanmalıdır. Öte yandan, konvansiyonel koroner baypas cerrahisine kıyasla KE ek mortalite ile ilişkilendirilemeyebilir. Anah tar söz cük ler: Koroner damarlar; endarterektomi; takip çalışmaları; morbidite; mortalite. Background:This study aims to investigate the effect of coronary endarterectomy (CE) on morbidity and mortality in patients undergoing concomitant coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed 587 patients who underwent CABG surgery with concomitant CE (CABG+CE group) and patch plasty between March 2000 and April 2010. We compared these patients with randomly selected 600 patients who had undergone CABG surgery without CE (CABG only group) in the same period. A comprehensive evaluation of the groups was achieved by subgroup analysis with large series of parameters from patient files. Results: The patients in the CABG+CE group were older than the patients in the CABG only group (59.6±10.3 vs. 61.3±7.3; p<0.001). The incidence of atherosclerotic risk factors, triplevessel disease, and complaints of unstable angina pectoris were slightly higher in CABG+CE group (p<0.05). Concomitant CE prolonged cross-clamp and cardiopulmonary bypass time. Also, postoperative total entubation time (12±10.3 vs. 12±7.4 hours; p<0.05) was significantly longer (p<0.05). The rates of myocardial infarction (p= 0.006) and intra-aortic balloon pump requirement (p<0.001) were significantly higher in the CABG+C...

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Early and late results of coronary endarterectomy

Cited by 120 publications

References 29 publications

Clinical Results of Endarterectomy of the Right and Left Anterior Descending Coronary Arteries

Clinical Results of Endarterectomy of the Right and Left Anterior Descending Coronary Arteries

Coronary endarterectomy in the left anterior descending artery

The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting

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