Shuichiro Takanashi1, Toshihiro Fukui, Yuji Miyamoto. 1. Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan. takanashi-s@gem.hi-ho.ne.jp
Abstract
BACKGROUND: The diffusely diseased coronary artery is a challenge for cardiac surgeons. Although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel, it has not been widely used. We assessed the early clinical and angiographic outcomes of patients undergoing coronary endarterectomy of the left anterior descending artery (LAD) with a patch plasty method using the left internal thoracic artery (LITA). Furthermore, we assessed the coronary artery velocity flow reserve (CFVR) of the endarterectomized LAD. METHODS: We retrospectively reviewed the records of 148 patients undergoing LAD endarterectomy using the in situ LITA. Direct endarterectomy was performed with a long segmental incision of the LAD that was reconstructed with the longitudinally incised LITA. The mean age at surgery was 65.1±8.6 years. Previous myocardial infarction was observed in 58.1% of the patients. The mean Canadian Cardiovascular Society score was 2.4±0.9. Postoperative angiography was performed in 134 patients (91.2%) during the same hospitalization (mean, 11.2±9.0 postoperative days). CFVR in the LAD was measured early after the operation by transthoracic echocardiography. RESULTS: The mean number of distal anastomoses per patient was 4.2±1.3. The mean length of reconstructed LAD with endarterectomy was 5.8±1.5 cm. The operative mortality was 2.7%. Low cardiac output occurred in 6.1% of the patients. Perioperative myocardial infarction was observed in 12.2% of the patients, but severe ventricular arrhythmia was not encountered. The patency rate of the LITA to LAD was 94.0% by early angiographic examination. The mean CFVR in the endarterectomized LAD was 2.41±0.66. CONCLUSIONS: Coronary endarterectomy of the LAD with a patch plasty using the LITA is associated with acceptable mortality, morbidity, and angiographic patency. CVFR measured by transthoracic echocardiography showed a favorable functional status in the endarterectomized LAD. Endarterectomy is considered to be one of the available surgical methods for patients with a diffusely diseased LAD.
BACKGROUND: The diffusely diseased coronary artery is a challenge for cardiac surgeons. Although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel, it has not been widely used. We assessed the early clinical and angiographic outcomes of patients undergoing coronary endarterectomy of the left anterior descending artery (LAD) with a patch plasty method using the left internal thoracic artery (LITA). Furthermore, we assessed the coronary artery velocity flow reserve (CFVR) of the endarterectomized LAD. METHODS: We retrospectively reviewed the records of 148 patients undergoing LAD endarterectomy using the in situ LITA. Direct endarterectomy was performed with a long segmental incision of the LAD that was reconstructed with the longitudinally incised LITA. The mean age at surgery was 65.1±8.6 years. Previous myocardial infarction was observed in 58.1% of the patients. The mean Canadian Cardiovascular Society score was 2.4±0.9. Postoperative angiography was performed in 134 patients (91.2%) during the same hospitalization (mean, 11.2±9.0 postoperative days). CFVR in the LAD was measured early after the operation by transthoracic echocardiography. RESULTS: The mean number of distal anastomoses per patient was 4.2±1.3. The mean length of reconstructed LAD with endarterectomy was 5.8±1.5 cm. The operative mortality was 2.7%. Low cardiac output occurred in 6.1% of the patients. Perioperative myocardial infarction was observed in 12.2% of the patients, but severe ventricular arrhythmia was not encountered. The patency rate of the LITA to LAD was 94.0% by early angiographic examination. The mean CFVR in the endarterectomized LAD was 2.41±0.66. CONCLUSIONS: Coronary endarterectomy of the LAD with a patch plasty using the LITA is associated with acceptable mortality, morbidity, and angiographic patency. CVFR measured by transthoracic echocardiography showed a favorable functional status in the endarterectomized LAD. Endarterectomy is considered to be one of the available surgical methods for patients with a diffusely diseased LAD.
Authors: Paolo Nardi; Marco Russo; Guglielmo Saitto; Emanuele Bovio; Sara Rita Vacirca; Carlo Bassano; Antonio Scafuri; Antonio Pellegrino; Giovanni Ruvolo Journal: Kardiochir Torakochirurgia Pol Date: 2018-12-31