Long-term outcome after coronary endarterectomy adjunct to coronary artery bypass grafting

Janiec, Mikael; Ragnarsson, Sigurður; Nozohoor, Shahab

doi:10.1093/icvts/ivy363

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…In these cases, CE had its priority when used adjunctively to CABG. Unlike early study results, researchers reported improved early and late outcomes after CE + CABG in several individual studies during last two decades [3,4,20], although most of the studies were restricted with observational design. Undoubtedly, these results might be attributed to the improvement in operative techniques and postoperative management.…”

Section: Discussionmentioning

confidence: 91%

Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study

Yan

Tiemuerniyazi

Song

et al. 2020

J Cardiothorac Surg

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Background: Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) can be the only option for complete revascularization in some patients with diffuse coronary artery disease. Unfortunately, CE can cause the lack of endothelium, resulting in increased risk of thrombotic events. Therefore, antithrombotic therapy is very important after surgery. However, there's no consistent protocol exists till now. The aim of this study was to compare the effectiveness and safety of dual antiplatelet therapies (DAPT) including aspirin plus clopidogrel (AC) or ticagrelor (AT) after CE + CABG. Method: A total of 137 continuous patients (mean age 60.0 ± 9.0 years) underwent CE + CABG from January 2016 to July 2018 in our center, and patients who received dual antiplatelet therapy (DAPT) after surgery (n = 121) were included in this study. All of the patients received aspirin 100 mg daily therapy after surgery, and 67 of the patients received extra clopidogrel 75 mg (AC) daily therapy, whereas 54 received extra ticagrelor 90 mg (AT) twice daily. All patients continued aspirin monotherapy after 1 year. Occurrence of ischemic events and bleeding events between two groups were compared. Kaplan-Meier survival was used to compare freedom from major adverse cardiovascular and cerebrovascular events (MACCE) between two groups, and log-rank test was used to confirm statistical difference. Results: Follow-up was completed by 99.2%, and median follow-up time was 30.0(22.5, 35.2) months. No operative death was observed, while perioperative myocardial infarction was observed in 2(1.7%) patients (AC 1.5% vs. AT 1.9%, p = ns). One patient in AC group suffered from cardiac tamponade. During the follow-up period, no death was observed. Ischemic events including nonfatal myocardial infarction, repeat revascularization and ischemic stroke were observed in 6(5.0%) patients (AC 4.5% vs. AT 5.6%, p = ns). Overt bleeding had occurred in 3(2.5%) patients (AC 3.0% vs. AT 1.9%, p = ns). Kaplan-Meier analysis indicated that MACCE-free survival of the two groups at 3 years was 97.0% in the AC group versus 94.1% in the AT group (p = ns). Conclusion: In patients undergoing CE + CABG, DAPT therapy can be effective and safe with comparable results between AC and AT therapy in terms of ischemic and bleeding events. Further studies are needed.

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Section: Discussionmentioning

confidence: 91%

Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study

Yan

Tiemuerniyazi

Song

et al. 2020

J Cardiothorac Surg

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“…Notwithstanding, recent studies on CE have reported better short-term survival rates ranging from 1.8 to 4%, and lower MACCE rates. 17,18 A contemporary study from China 19 reported 30-day mortality rates at 1.4% and perioperative MI rates at 4.1% and a similar study in Germany 20 also reported 30-day mortality of 1.8% and periprocedural MI at 3.6%. In our cohort, the 30-day mortality rate was 2.5% and one-year all-cause mortality was 6.2%.…”

Section: Discussionmentioning

confidence: 97%

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

Chow

Kwok

et al. 2021

Asian Cardiovasc Thorac Ann

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Background Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. Methods Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan–Meier and logistic regression analysis. Results The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). Conclusions Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.

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“…In despite of increasing early risks of morbidity and mortality after CE, the long-term outcomes of CABG+CE were not inferior to the CABG alone. A propensity matched cohorts study (1074 patients) comparing the long-term outcomes in patients undergone CABG with or without CE suggested no significant difference in terms of survival rate (65.8% versus 70.7%) and coronary reintervention (11.6% versus 12.7%) during10 years follow-up [ 16 ]. Furthermore, Schwann et al analyzed the late graft patency of 288 patients undergone CABG+CE, and found that the graft failure rate after CABG+CE vs CABG alone was no significant difference during 1-year follow-up [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative intra-aortic balloon pump improves 30-day outcomes of patients undergoing extensive coronary endarterectomy

Liu

Fang

et al. 2020

J Cardiothorac Surg

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Background The efficacy of intra-aortic balloon pump (IABP) has been proven in high-risk patients undergoing coronary artery bypass grafting (CABG). However, data on the timing and benefits of IABP support in diffuse coronary artery disease after CABG combined with coronary endarterectomy (CE) remain scarce. This retrospective study assessed the effect of intraoperative or postoperative IABP on 30-day outcomes of off-pump CABG+CE. Methods From January 2012 to December 2018, 546 patients undergone off-pump CABG+CE were divided into control group ( n = 437) and IABP group ( n = 109). Risk factors for 30-day outcomes were evaluated. Subgroup analysis from IABP group was conducted to identify the effect of timing IABP on 30-day outcomes. Results CE on left anterior descending branch of coronary artery (LAD) (OR = 3.079, 95% CI 1.077–8.805, P = 0.036), CE with≥2 vessels (OR = 9.123, 95% CI 3.179–26.033, P < 0.001) and length of atherosclerotic plaque ≥3 cm (OR = 16.017, 95% CI 5.941–43.183, P < 0.001) were independent risk factors for postoperative acute myocardial infarction (AMI) and 30-day mortality. Comparing with intraoperative IABP support, postoperative IABP support (OR = 3.987, 95% CI1.194–13.317, P = 0.025) was closely associated with postoperative AMI and 30-day mortality. Conclusions For patients undergone off-pump CABG and extensive CE (CE on LAD, CE ≥2 vessels and length of atherosclerotic plaque ≥3 cm), intraoperative IABP support may improve 30-day outcomes.

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Long-term outcome after coronary endarterectomy adjunct to coronary artery bypass grafting

Cited by 10 publications

References 14 publications

Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study

Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

Intraoperative intra-aortic balloon pump improves 30-day outcomes of patients undergoing extensive coronary endarterectomy

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