Early Clinical Outcomes and Mortality of Coronary Endarterectomy in the Left Anterior Descending Artery: A Single-Center Experience

Document Type: Original Article

Authors

1 Cardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences, Atherosclerosis Prevention Research Center, Imam Reza Hospital. Iran

2 Cardiac Surgeon, Department of cardiac surgery, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .

3 Medical Student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Medical Student, Faculty of Medicine, Mashhad University of Medical Sciences, Iran

5 Cardiac Surgeon, Atherosclerosis Prevention Research Center, cardiac surgery Imam Reza Hospital, Mashhad University of Medical Sciences,

Abstract

Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only available option for cardiac surgeons in some patients with diffuse coronary artery disease. Based on the majority of conducted studies, the results of coronary endarterectomy (including survival, graft patency, and recurrence of the symptoms of myocardial ischemia) are less prevalent than standard coronary artery bypass grafting. Generally, the left anterior descending artery (LAD) is the most commonly involved artery in coronary endarterectomy. The aim of this study was evaluate clinical and early results of  Endarterectomy of LAD artery.
Materials & Methods:  In total, 30 cases of coronary endarterectomy of the LAD were studied from January 2015 until January 2016.this is a retrospective study that  Endarterectomy procedure was performed in Imamreza hospital of Mashhad university of medical sciences.
Results: The mean age of the subjects was 63±4.5 years (range: 45-78 years). As the findings revealed, eighteen patients were male (60%), and the mean ejection fraction index was 43±5.1 (range: 15-60). Also, prior history of myocardial infarction was documented in 8 (26%) patients. The mortality rate among patients was estimated at 6.6% (n=2). In total, 12 (40%) and 7 (23%) patients required high-dose inotropic support and intra-aortic balloon pump, respectively. Risk of preoperative myocardial infarction was observed in 5 (16.5%) cases, and 3 (10%) patients required re-exploration due to significant hemorrhage.
Conclusion: If coronary endarterectomy of the LAD is performed by experienced cardiac surgeons, favorable outcomes can be obtained.

Keywords


1. Abid AR, Farogh A, Naqshband MS, Akhtar RP, Khan JS. Hospital outcome of coronary artery bypass grafting and coronary endarterectomy.Asian Cardiovasc Thorac Ann. 2009; 17:59–63

 

2. Akchurin RS, Brand I, Barskova T. Assessment of efficacy of endarterectomy of coronary arteries. Khirurgiia. 2003; 10:21–24.

 

3. Erdil N, Cetin L, Kucuker S, Demirkilic U, Sener E, Tatar H.. Closed endarterectomy for diffuse right coronary artery disease: early results with angiographic controls. J Card Surg. 2002; 17:261–266.

 

4. Fukui T, Takanashi S, Hosoda Y. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg. 2005; 80:2098–2105.

 

5. Authors/Task Force MWindecker S, Kolh P, et al. 2014 ESC/ EACTS guidelines on myocardial revascularization: The task force on myocardial revascularization of the European Society of Cardiol- ogy (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur Heart J. 2014; 35:2541–2619.

 

6. Yoo JS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Coronary artery bypass grafting in patients with left ventricular dysfunction: predictors of long-term survival and impact of surgical strategies. Int J Cardiol. 2013; 168:53 16–5322.

 

7. Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarter- ectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014; 19:462–473.

 

8. irivella S, Gielchinsky I, Parsonnet V. Results of coronary artery endarterectomy and coronary artery bypass grafting for diffuse coronary artery disease. Ann Thorac Surg.2005; 80:1738–1744.

 

9. Silberman S, Dzigivker I, Merin O, Shapira N, Deeb M, Bitran D. Does coronary endarter- ectomy increase the risk of coronary bypass? J Card Surg. 2002;17:267–271.

 

10. Tiruvoipati R, Loubani M, Lencioni M, Ghosh S, Jones PW, Patel RL. Coronary endarter- ectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg. 2005; 79:1999– 2003

 

11. Fukui T, Tabata M, Taguri M, Manabe S, Morita S, Takanashi S. Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg. 2011; 91:445–451.

 

12. Kato Y, Shibata T, Takanashi S, Fukui T, Ito A, Shimizu Y. Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery. Ann Thorac Surg. 2012;93:1195–1200

 

13. Qiu Z, Chen X, Jiang Y, Wang L, Xu M, Huang F, et al. Comparison of off-pump and on- pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome. J Cardiothorac Surg. 2014;9:186

 

14. Naseri E, Sevinc M, Erk MK. Comparison of off-pump and conventional coronary endarterectomy. Heart Surg Forum. 2003;6:216–219

 

15. Hussain I, Ghaffar A, Shahbaz A, Sami W, Muhammad A, Seher N,. In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG. J Ayub Med Coll Abbottabad. 2008;20:31–37.

 

16. Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 2003; 23:168–175