Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery

Kosaku Nishigawa, Toshihiro Fukui, Masataka Yamazaki, Shuichiro Takanashi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Coronary endarterectomy (CE) is a surgical option for a diffusely diseased coronary artery. This study evaluated the clinical and angiographic outcomes of CE for a diffusely diseased left anterior descending artery (LAD) using the internal thoracic artery (ITA). Methods From September 2004 to September 2014, 188 patients (163 men; mean age, 66.1 years) underwent coronary artery bypass grafting with CE for a diffusely diseased LAD. Forty patients (21.3%) had unstable angina, and 55 (29.3%) were at Canadian Cardiovascular Society class 3 or 4. Mean ejection fraction was 0.55. Endarterectomy was performed under direct vision through a long arteriotomy in all patients. Angiographic evaluation was performed before discharge and at 1 year after the operation. Results Mean arteriotomy length was 6.1 ± 1.8 cm. The endarterectomized LAD was reconstructed using the left ITA in 179 (95.2%) or the right ITA in 9 (4.8%). The operation was conducted off pump in 185 patients (98.4%). The 30-day mortality was 1.1%. Perioperative myocardial infarction occurred in 17 patients (9.0%). The patency rate of the ITA and LAD at early postoperative and follow-up angiography was 91.6% and 96.6%, respectively. Optical coherence tomography performed in 8 patients revealed that the endarterectomized LAD was completely endothelialized and that the surface of the reconstructed lumen had become homogeneous within 1 year after the operation. The median follow-up period was 5.8 years. At 5 years, freedom from all-cause death was 89.3% ± 2.4% and freedom from major adverse cardiac and cerebrovascular events was 74.0% ± 3.3%. Conclusions CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.

Original languageEnglish
Pages (from-to)710-716
Number of pages7
JournalAnnals of Thoracic Surgery
Volume103
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1
Externally publishedYes

Fingerprint

Endarterectomy
Mammary Arteries
Arteries
Unstable Angina
Optical Coherence Tomography
Coronary Artery Bypass
Coronary Artery Disease
Cause of Death
Angiography
Myocardial Infarction
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery. / Nishigawa, Kosaku; Fukui, Toshihiro; Yamazaki, Masataka; Takanashi, Shuichiro.

In: Annals of Thoracic Surgery, Vol. 103, No. 3, 01.03.2017, p. 710-716.

Research output: Contribution to journalArticle

Nishigawa, Kosaku ; Fukui, Toshihiro ; Yamazaki, Masataka ; Takanashi, Shuichiro. / Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 3. pp. 710-716.
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abstract = "Background Coronary endarterectomy (CE) is a surgical option for a diffusely diseased coronary artery. This study evaluated the clinical and angiographic outcomes of CE for a diffusely diseased left anterior descending artery (LAD) using the internal thoracic artery (ITA). Methods From September 2004 to September 2014, 188 patients (163 men; mean age, 66.1 years) underwent coronary artery bypass grafting with CE for a diffusely diseased LAD. Forty patients (21.3{\%}) had unstable angina, and 55 (29.3{\%}) were at Canadian Cardiovascular Society class 3 or 4. Mean ejection fraction was 0.55. Endarterectomy was performed under direct vision through a long arteriotomy in all patients. Angiographic evaluation was performed before discharge and at 1 year after the operation. Results Mean arteriotomy length was 6.1 ± 1.8 cm. The endarterectomized LAD was reconstructed using the left ITA in 179 (95.2{\%}) or the right ITA in 9 (4.8{\%}). The operation was conducted off pump in 185 patients (98.4{\%}). The 30-day mortality was 1.1{\%}. Perioperative myocardial infarction occurred in 17 patients (9.0{\%}). The patency rate of the ITA and LAD at early postoperative and follow-up angiography was 91.6{\%} and 96.6{\%}, respectively. Optical coherence tomography performed in 8 patients revealed that the endarterectomized LAD was completely endothelialized and that the surface of the reconstructed lumen had become homogeneous within 1 year after the operation. The median follow-up period was 5.8 years. At 5 years, freedom from all-cause death was 89.3{\%} ± 2.4{\%} and freedom from major adverse cardiac and cerebrovascular events was 74.0{\%} ± 3.3{\%}. Conclusions CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.",
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AB - Background Coronary endarterectomy (CE) is a surgical option for a diffusely diseased coronary artery. This study evaluated the clinical and angiographic outcomes of CE for a diffusely diseased left anterior descending artery (LAD) using the internal thoracic artery (ITA). Methods From September 2004 to September 2014, 188 patients (163 men; mean age, 66.1 years) underwent coronary artery bypass grafting with CE for a diffusely diseased LAD. Forty patients (21.3%) had unstable angina, and 55 (29.3%) were at Canadian Cardiovascular Society class 3 or 4. Mean ejection fraction was 0.55. Endarterectomy was performed under direct vision through a long arteriotomy in all patients. Angiographic evaluation was performed before discharge and at 1 year after the operation. Results Mean arteriotomy length was 6.1 ± 1.8 cm. The endarterectomized LAD was reconstructed using the left ITA in 179 (95.2%) or the right ITA in 9 (4.8%). The operation was conducted off pump in 185 patients (98.4%). The 30-day mortality was 1.1%. Perioperative myocardial infarction occurred in 17 patients (9.0%). The patency rate of the ITA and LAD at early postoperative and follow-up angiography was 91.6% and 96.6%, respectively. Optical coherence tomography performed in 8 patients revealed that the endarterectomized LAD was completely endothelialized and that the surface of the reconstructed lumen had become homogeneous within 1 year after the operation. The median follow-up period was 5.8 years. At 5 years, freedom from all-cause death was 89.3% ± 2.4% and freedom from major adverse cardiac and cerebrovascular events was 74.0% ± 3.3%. Conclusions CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.

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