Long-term outcomes of reconstructive procedures on coronary arteries for diffuse coronary atherosclerosis without endarterectomy
https://doi.org/10.35401/2500-0268-2020-20-4-6-13
Abstract
Objective. This study evaluated the long-term clinical and angiographic outcomes of coronary artery reconstruction for a diffusely diseased coronary artery without endarterectomy.
Material and Methods. We retrospectively reviewed 660 consecutive patients (mostly men (89.5%), mean age 68.3 ± 7.4 years) who underwent coronary artery bypass grafting in combination with coronary artery reconstruction between 2003 and 2016. 558 operated on patients (84.5%) were followed up for a mean of 94.3 ± 31.2 months.
Results. Long-term survival was 83.2% (95% confidence interval: 74.5–89.3); freedom from cardiac death was 97.4 ± 1.2%; and freedom from major adverse cardiac and cerebrovascular events was 64.7 ± 4.1%. Independent predictors of long-term mortality were age at surgery (< 70 years, p < 0.001), chronic obstructive pulmonary disease (p = 0.007), peripheral arterial disease (p = 0.002), diabetes mellitus (p = 0.013) and chronic kidney disease (p = 0.034). The arterial graft patency rate was 95.2%, and the vein graft patency rate was 75.4%.
Conclusion. Coronary artery bypass grafting in conjunction with coronary artery reconstruction without endarterectomy confers satisfactory long-term clinical outcomes with high probability of freedom from cardiac death and angina pectoris, good rates of angiographic patency of arterial grafts and favorable rates of vein graft patency.
About the Authors
S. A. Belash
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1; Kuban State Medical University
Russian Federation
Russian Federation
Sergey A. Belash, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiac Surgery Department no. 2
Krasnodar
S. S. Shevchenko
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1
Russian Federation
Russian Federation
Sergey S. Shevchenko, Cardiovascular Surgeon, Cardiac Surgery Department no. 2
Krasnodar
E. P. Yasakova
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1
Russian Federation
Russian Federation
Elena P. Yasakova, Radiologist, Department of Radiation Diagnostics
Krasnodar
K. O. Barbukhatti
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1; Kuban State Medical University
Russian Federation
Russian Federation
Kirill O. Barbukhatti, Dr. of Sci. (Med.), Head of the Cardiac Surgery Department no. 2; Head of the Department of Cardiac Surgery and Cardiology, Department of Proficiency Enhancement
Krasnodar
V. A. Porhanov
Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1; Kuban State Medical University
Russian Federation
Russian Federation
Vladimir A. Porhanov, Member of the Russian Academy of Sciences, Dr. of Sci. (Med.), Professor, Chief Doctor ; Head of the Department of Oncology with the Course of Thoracic Surgery, Department of Proficiency Enhancement
Krasnodar
References
1. Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014;19:462–73. PMID: 24893867. https://doi.org/10.1093/icvts/ivu157
2. Ghatanatti R, Teli A. Coronary endarterectomy: recent trends. J Clin Diagn Res. 2017;11:PE01–4. PMID: 28969206. PMCID: PMC5620847. https://doi.org/10.7860/JCDR/2017/27036.10339
3. Wang Ch, Chen J, Gu Ch, Li J. Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2019;29:393–401. PMID: 31180487. https://doi.org/10.1093/icvts/ivz125
4. Aoki J, Ong AT, Rodriguez Granillo GA, et al. “Full metal jacket” (stented length ≥64 mm) using drug-eluting stents for de novo coronary artery lesions. Am Heart J. 2005;150:994–9. PMID: 16290984. https://doi.org/10.1016/j.ahj.2005.01.050
5. Tsagalou E, Chieffo A, Iakovou I, et al. Multiple overlapping drug-eluting stents to treat diffuse disease of the left anterior descending coronary artery. J Am Coll Cardiol. 2005;45:1570–3. PMID: 15893168. https://doi.org/10.1016/j.jacc.2005.01.049
6. Fukui T, Tabata M, Taguri M, Manabe S, Morita S, Takanashi Sh. Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg. 2011;91:445–51. PMID: 21256288. https://doi.org/10.1016/j.athoracsur.2010.10.002
7. Rocha AS, Dassa NP, Pittella FJ, et al. High mortality associated with precluded coronary artery bypass surgery caused by severe distal coronary artery disease. Circulation. 2005;112:I328–31. PMID: 16159841. https://doi.org/10.1161/CIRCULATIONAHA.104.525717
8. Lozano I, Capin E, de la Hera E-M, Llosa JC, Carro A, López-Palop R. Diffuse coronary artery disease not amenable to revascularization: long-term prognosis. Rev Esp Cardiol (Engl Ed). 2015;68:629–40. PMID: 25936615. https://doi.org/10.1016/j.rec.2015.02.013
9. Baranauskas A, Peace A, Kibarskis A, et al. FFR result post PCI is suboptimal in long diffuse coronary artery disease. EuroIntervention. 2016;12:1473–80. PMID: 27998839. https://doi.org/10.4244/EIJ-D-15-0051412
10. Brown RA, Shantsila E, Varma Ch, Lip GY. Epidemiology and pathogenesis of diffuse obstructive coronary artery disease: the role of arterial stiffness, shear stress, monocyte subsets and circulating microparticles. Ann Med. 2016;48:444–55. PMID: 27282244. https://doi.org/10.1080/07853890.2016.1190861
11. Fukui T, Takanashi Sh, Hosoda Ya. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg. 2005;80:2098–105. PMID: 16305852. https://doi.org/10.1016/j.athoracsur.2005.06.047
12. Kato Ya, Shibata T, Takanashi Sh, Fukui T, Ito A, Shimizu Yo. Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery. Ann Thorac Surg. 2012;93:1195–200. PMID: 22381445. https://doi.org/10.1016/j.athoracsur.2011.12.059
13. Belash SA, Barbukhatti KO, Porhanov VA. Comparative analysis of early results of reconstructive procedures on coronary arteries with or without endarterectomy in diffuse coronary atherosclerosis. Russian Journal of Thoracic and Cardiovascular Surgery. 2019;61(1):45–54. (In Russ.). https://doi.org/10.24022/0236-2791-2019-61-1-45-54
14. Zimarino M, Ricci F, Romanello M, Di Nicola M, Corazzini A, De Caterina R. Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: a meta-analysis of randomized and observational studies. Catheter Cardiovasc Interv. 2016;87:3–12. PMID: 25846673. https://doi.org/10.1002/ccd.25923
15. Garcia S, Sandoval Ya, Roukoz H, et al. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol. 2013;62:1421–31. PMID: 23747787. https://doi.org/10.1016/j.jacc.2013.05.033
16. Akchurin RS, Salichkin DV, Emelyanov AV, Galyautdinov DV, Vasilyev VP, Shiryaev AA. Coronary artery bypass grafting for diffuse and distal lesions of the coronary arteries. Kardiologicheskiy vestnik = Russian Cardiology Bulletin. 2015;Х(4):50–5. (In Russ.)
17. Akchurin RS, Shiryaev AA, Vasilyev VP, Galyautdinov DV, Vlasova EE. Modern trends in coronary surgery. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2017;21(3s):34–44. (In Russ.). https://doi.org/10.21688/1681-3472-2017-3S-34-44
18. Akchurin RS, Shiryaev AA, Vasilyev VP, et al. Early and long-term outcomes of coronary bypass in patients with previous percutaneous coronary intervention. Kardiologiya i serdechno-sosudistaya khirurgiya = Russian Journal of Cardiology and Cardiovascular Surgery. 2016;9(4):11–16. (In Russ.). https://doi.org/10.17116/kardio20169411-16
19. Alekyan BG, Zakaryan NV, Staferov AV, Sargsyan AZ, Kadyrov BA. Early results of endovascular treatment of patients who were refused surgical myocardial revascularization due to coronary artery bypass graft. Grudnaya i serdechno-sosudistaya khirurgiya = Russian Journal of Thoracic and Cardiovascular Surgery. 2013;3:14–8. (In Russ.)
20. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130:1749–67. PMID: 25070666. https://doi.org/10.1161/CIR.0000000000000095
21. Graham MH, Chambers RJ, Davies RF. Angiographic quantification of diffuse coronary artery disease: reliability and prognostic value for bypass operations. J Thorac Cardiovasc Surg. 1999;118:618–27. PMID: 10504625. https://doi.org/10.1016/s0022-5223(99)70006-1
22. Kleisli T, Cheng W, Jacobs MJ, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2005;129:1283–91. PMID: 15942568. https://doi.org/10.1016/j.jtcvs.2004.12.034
23. Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: the current state of knowledge. Atherosclerosis. 2016;249:88–98. PMID: 27085158. https://doi.org/10.1016/j.atherosclerosis.2016.03.036
24. Bezon E. Coronary artery reconstruction: optimal technique of coronary endarterectomy. Ann Thorac Surg. 2006;82:2341–2. https://doi.org/10.1016/j.athoracsur.2006.04.006
25. Takahashi M, Gohil S, Tong B, Lento P, Filsoufi F, Reddy RC. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg. 2013;16:301–5. PMID: 23190620. PMCID: PMC3568806. https://doi.org/10.1093/icvts/ivs482
26. Wang J, Gu Ch, Yu W, Gao M, Yu Ya. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: a meta-analysis of 63,730 patients (PRISMA). Medicine (Baltimore). 2015;94:e1781. PMID: 26469920. PMCID: PMC4616783. https://doi.org/10.1097/MD.0000000000001781
27. Bitan O, Pirundini PA, Leshem E, et al. Coronary endarterectomy or patch angioplasty for diffuse left anterior descending artery disease. Thorac Cardiovasc Surg. 2018;66:491–7. PMID: 28315286. https://doi.org/10.1055/s-0037-1600918
28. Costa M, Betero AL, Okamoto J, Schafranski M, Reis E, Gomes RZ. Coronary endarterectomy: a case control study and evaluation of early patency rate of endarterectomized arteries. Braz J Cardiovasc Surg. 2020;35:9–15. PMID: 32270954. PMCID: PMC7089746. https://doi.org/10.21470/1678-9741-2018-0402
29. Li D, Guo P, Chen L, Wu Y, Wang G, Xiao C. Outcomes of surgical patch angioplasty of the coronary artery for diffuse coronary artery disease. Braz J Cardiovasc Surg. 2020. Epub April 22. [published online ahead of print]. https://doi.org/10.21470/1678-9741-2019-0390
30. Ogus TN, Basaran M, Selimoglu O, et al. Long-term results of the left anterior descending coronary artery reconstruction with left internal thoracic artery. Ann Thorac Surg. 2007;83:496–501. PMID: 17257976. https://doi.org/10.1016/j.athoracsur.2006.09.073
31. Caparrelli DJ, Ghazoul M, Diethrich EB. Indications for coronary artery bypass grafting in 2009: what is left to surgery. J Cardiovasc Surg. (Torino). 2009;50:19–28. PMID: 19179987.
32. Taşdemir O, Kiziltepe U, Karagöz HY, Yamak B, Korkmaz S, Bayazit K. Long-term results of reconstructions of the left anterior descending coronary artery in diffuse atherosclerotic lesions. J Thorac Cardiovasc Surg. 1996;112:745–54. PMID: 8800164. https://doi.org/10.1016/s0022-5223(96)70061-2
33. Shehada Sh-E, Mourad F, Balaj I, et al. Long-term outcomes of coronary endarterectomy in patients with complete imaging follow-up. Semin Thorac Cardiovasc Surg. 2019; Apr 22;S1043-0679(19)30095-4. [published online ahead of print]. PMID: 31022447. https://doi.org/10.1053/j.semtcvs.2019.04.008
Review
For citations:
Belash S.A., Shevchenko S.S., Yasakova E.P., Barbukhatti K.O., Porhanov V.A. Long-term outcomes of reconstructive procedures on coronary arteries for diffuse coronary atherosclerosis without endarterectomy. Innovative Medicine of Kuban. 2020;(4):6-13. (In Russ.) https://doi.org/10.35401/2500-0268-2020-20-4-6-13
Views:
551
Email this article 
