Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

Abstract Coronary endarterectomy is an old surgical procedure against coronary artery disease which was first described by Baily et al. in 1957. In spite of the first adverse effects, several recent publications have demonstrated that coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) can be done safely with appropriate mortality and morbidity. The main objective of CABG is complete revascularization of coronary vessels and, particularly, left internal mammary artery to left anterior descending artery (LIMA-LAD) anastomosis, Since; patent LIMA-LAD is the single most significant determinant for long-term and eventfree survival. A best evidence topic in cardiac surgery was written according to a structured protocol. The problem was whether LAD artery open endarterectomy (open-CE) with CABG compares favorably with LAD artery closed endarterectomy (closed-CE) with CABG in the myocardial revascularization of patients presenting with diffuse coronary artery disease (DCAD). The purpose of this review is just to determine the safety and feasibility of CE in general and open-CE versus closed-CE particularly. The last search date was December 2019 and the search period was from 1992 till 2019. Open-CE with CABG may carry a lower early mortality rate (range from 2.9% to 8.8%) than closed-CE with CABG (range from 6.8% to 10.9%) and CE + CABG has a significantly higher risk of death than isolated CABG. Internal thoracic artery (ITA) use may enhance mortality, while the saphenous vein (SV) conduit or two CE vessels may worsen the clinical outcome. The main complication of CE can be found in post-operative atrial fibrillation (AF), in our review; the rate ranged from 9% to 29%. Another devastating complication is postoperative myocardial infarction (MI) with a range of 0% to 13.9%.

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Distribution of Thoracic Aortic Calcifications in Patients Undergoing Coronary Artery Bypass Grafting

Aorta ◽

10.12945/j.aorta.2017.17.035 ◽

2017 ◽

Vol 05 (05) ◽

pp. 132-138 ◽

Cited By ~ 3

Author(s):

Adem Diken ◽

Adnan Yalçınkaya ◽

Sertan Özyalçın

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Classification System ◽

Artery Bypass ◽

Ascending Aorta ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Artery Disease

Background: In procedures involving surgical maneuvers such as cannulation, clamping, or proximal anastomosis where aortic manipulation is inevitable, a preliminary assessment of atherosclerotic plaques bears clinical significance. In the present study, our aim was to evaluate the frequency and distribution of aortic calcifications in patients undergoing coronary artery bypass grafting (CABG) surgery to propose a morphological classification system. Methods: A total of 443 consecutive patients with coronary artery disease were included in this study. Preoperative non-contrast enhanced computed tomography images, in-hospital follow-up data, and patient characteristics were retrospectively evaluated. Results: Whereas 33% of patients had no calcifications at any site in the aorta, 7.9%, 75.4%, and 16.7% had calcifications in the ascending aorta, aortic arch, and descending aorta, respectively. Focal small calcifications were the most common type of lesions in the ascending aorta (3.9%), whereas 9 patients (1.4%) had porcelain ascending aorta. We defined four types of patients with increasing severity and extent of calcifications. Conclusions: Based on the frequency and distribution of calcifications in the thoracic aorta, we propose a classification system from least to most severe for coronary artery disease patients who are candidates for CABG.

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