Open Endarterectomy with Vein-Patch Coronary Reconstruction and Internal Mammary Artery Implant

Fundarò, P; Biasi, Pietro Di; Santoli, Edoardo; Botta, Mario; Santoli, C

doi:10.1007/978-3-642-74629-1_45

Cited by 10 publications

(19 citation statements)

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“…Endarterectomy combined with vein-patch reconstruction remains, however, a viable option in these patients [7][8][9][10][11][12]. As described by Ladowski et al [9], this recent technique involves opening the artery longitudinally at the target site, removing the plaque and reconstructing the vascular "roof" with a vein patch, over which the bypass is secured distally.…”

Section: Discussionmentioning

confidence: 99%

“…Nel 25% dei pazienti con malattia coronarica severa ed indirizzati alla chirurgia per l'impossibilità al trattamento endovascolare, la tecnica chirurgica tradizionale non può essere applicata e tali pazienti sono spesso definiti inoperabili [1], rimanendo però percorribile l'opzione della endoarterectomia con ricostruzione mediante patch [7][8][9][10][11][12]. Quest'ultima recente tecnica, oggetto di studio di questo lavoro, prevede, come illustrato da Ladowski et al [9], l'apertura longitudinale del vaso arterioso nel punto previsto per l'innesto del by-pass con rimozione della placca e ricostruzione del "tetto" vascolare mediante innesto di parete venosa su cui si procede all'ancoraggio distale del by-pass: tale punto di ancoraggio del by-pass deve essere privo di alterazioni ateromasiche, evitando i rischi di una disseminazione embolica distale, tipica delle endoarterectomie della prima generazione [2,3].…”

Section: Discussioneunclassified

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Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussioneunclassified

Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction

et al. 2009

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“…Initially, a closed traction method with primary closure of the arteriotomy was practised [1] . Over time the procedure evolved to include patch closure of the arteriotomy combined with LIMA or saphenous vein bypass grafting [6,7,20,21] . In this study, all endarterectomies were performed under direct vision, exposing the whole arterial lumen and side branches and arteriotomy closure with vein patch with subsequent end to side grafting was done in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Primary coronary endarterectomy without coronary artery bypass grafting (CABG) was first introduced in 1957 by Bailey for the treatment of acute myocardial infarction [1][2][3] . Subsequently, endarterectomy was combined with CABG alone, and later by vein patch and left internal mammary (LIMA) bypass of the left anterior descending artery (LAD) [4][5][6][7][8] . Initial published reports showed a high incidence of perioperative mortality and ischemia [9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of long left coronary endarterectomy in patients with diffuse coronary artery disease

Radhakrishnan¹,

Galvin²,

El‐Gamel³

2019

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Aim: Historically the outcome of left coronary artery endarterectomy (LCAE) has been associated with increased morbidity and mortality when surgeons performed it with coronary artery bypass grafting (CABG). We aim to review outcomes after open LCAE-CABG in patients managed with aggressive dual antiplatelet therapy.Methods: From 1999 to 2007 open LCAE with CABG was performed in 87 patients. We compared the short and long-terms outcomes of 75 propensity-matched conventional CABG patients. Both groups were operated on by a single surgeon.Results: Sixty-six percent (66%; n = 58/87) of LCAE group had diffuse atheroma in Left anterior descending artery (LAD); 31% (n = 27/87) involved both LAD and branches of the circumflex artery (Cx); 3%; (n = 3/87) involved the Cx in isolation. Cross clamp time (43.29 vs. 59.04, P = 0.019) and bypass time (57.29 vs. 74.04, P = 0.007) were significantly higher in the LCAE group. There was no significant difference in early (1% vs. 1.3%) and late mortality (4% vs. 4.5% at 10 years). The hospital length of stay (5.58 vs. 6.67, P = 0.03), was higher in the LACE group when compared with the CABG group. The freedom from angina and long-term survival were not significantly different between the two groups. Conclusion:Patients undergoing CABG with Left-sided coronary endarterectomy had increased cross-clamp and bypass times with prolonged stay in hospital and increased blood transfusion rates. The mortality, morbidity, longterm survival and freedom from angina are not different when compared to CABG alone. The use of retrograde blood cardioplegia and aggressive antiplatelets may have contributed to the excellent outcome.

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“…It's a simpler technique but was criticized due to the possibility of occlusion of the distal LAD or its branches by insufficient endarterectomy the so called snowplow effect [7] . In addition blind traction on the atherosclerotic core can lead to tears and iatrogenic intimal flaps that would lead to occlusion of the coronary vessel [8] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of different surgical modalities for coronary reconstruction of diffusely diseased left anterior descending artery

Elsayed¹,

Hassanein²,

Keshk³

et al. 2018

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How to cite this article: Elsayed MH, Hassanein WM, Keshk SA, Zidan M, Etman WG. Evaluation of different surgical modalities for coronary reconstruction of diffusely diseased left anterior descending artery. Vessel Plus 2018;2:39. http://dx. AbstractAim: Endarterectomy has been shown to be an effective adjunct in treating diffusely diseased coronary arteries. Reconstruction of endarterectomized coronaries has been done by various techniques. We compare early results of left internal mammary artery (LIMA) patch to saphenous vein patch in left anterior descending artery (LAD) reconstruction. Methods:We prospectively followed 30 patients with diffusely diseased LAD from January 2016 to January 2018. Patients were followed up clinically, by echocardiogram and CT coronary angiography.Results: Twenty-seven patients were males (90%). The mean age was 59.23 ± 7.98. Twenty-two patients (73.3%) had a LIMA onlay patch. The mean length of patch reconstruction was greater in the saphenous vein group than LIMA group (8.31 ± 1.16 cm vs. 5.64 ± 0.73 cm, P < 0.001). Postoperative myocardial infarction occurred in 1 patient from the LIMA group (4.5%) and 1 patient in the saphenous vein patch group (12.5%). Operative mortality occurred in 1 patient belonging to the LIMA group. Mean time of follow up was 17.59 ± 6.34 months. CT coronary angiography showed a patency rate of 93.1%. Conclusion:Results of reconstruction by LIMA and saphenous vein patch are comparable in short-term follow up.

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Open Endarterectomy with Vein-Patch Coronary Reconstruction and Internal Mammary Artery Implant

Cited by 10 publications

References 10 publications

Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction

Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction

Outcomes of long left coronary endarterectomy in patients with diffuse coronary artery disease

Evaluation of different surgical modalities for coronary reconstruction of diffusely diseased left anterior descending artery

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