Medium-Term Survival of Diffuse Coronary Artery Disease Patients following Coronary Artery Reconstruction with the Internal Thoracic Artery

Abstract

Objective: Diffuse coronary artery disease makes cardiac surgeons hesitant regarding whether coronary artery bypass grafting (CABG) surgery is feasible or not. Coronary artery reconstruction using the internal thoracic artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary artery reconstruction. Methods: All patients undergoing coronary artery reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary artery reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary artery reconstruction using the ITA was associated with endarterectomy in 48 cases (17%). Results: In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years. Conclusions: Coronary artery reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions.

Survival and Angiographic Results After Endarterectomy From the Left Anterior Descending Artery

“…В среднем, по данным литературы, госпитальная летальность находится в пределах 2,0-6,5% [2,4,5]. Этот показатель выше, чем при обычном АКШ, однако многие авторы отмечают, что связано это, прежде всего, с сопутствующей патологией и тяжёлым исходным состоянием пациентов, а не с самой операцией [2,6].…”

“…По различным оценкам, его частота достигает 1,5-15% [2,3,6]. При ЭАЭ из нескольких бассейнов риск увеличивается [8].…”

Sirens versus Facts: Mastering Good Old Techniques in an Era of Innovation Enthusiasm

“…In a recent issue of Cardiology , Khalifa et al [1] reported the medium-term clinical results of a cohort of 233 patients submitted to surgical left anterior descending artery (LAD) reconstruction and bypass using the internal thoracic artery. …”

“…From a surgical standpoint, the procedure described by Khalifa et al [1] requires considerable expertise and is certainly more challenging compared to conventional coronary surgery. This is reflected by the longer cardiopulmonary bypass and cross-clamp times, although with the modern protocols for myocardial protection and cardiopulmonary bypass management these issues are of relatively minor concern.…”

“…In an era in which cardiac surgeons are more and more tempted by the siren song of minimally invasive surgery, Khalifa et al [1] opportunely remind us that excellent results and robust clinical benefits still are obtainable by the optimization and improvement of conventional surgical techniques.…”