Long-Term Results after Coronary Artery Reconstructive Surgery

Abstract

Background: Diffuse coronary artery disease, multiple consecutive stenoses and complex lesions are a common finding in coronary surgery. Coronary reconstructive surgery in terms of extended anastomoses with or without thromboendarterectomy is still controversially discussed. The aim of this study was to evaluate the long-term results of patients who underwent coronary reconstruction. Methods: Between January 1995 and June 2004, 640 consecutive, unselected patients underwent isolated CABG with coronary reconstructive surgery of the LAD at a single institution. A cross-sectional long-term follow-up was performed with a completeness of 99.2 %. Questionnaires were sent to all patients with a response rate of 83.2 % (n = 533). Results: 147 of the 640 patients (22.9 %) died during up the follow-up period which was up to 10 years. Of the 371 patients who responded to the questionnaires, the status of 54 patients (15.9 %), predominantly those with a preoperative lower NYHA class, remained unchanged, while 294 patients (79.2 %) improved by at least one NYHA class. Repeat angiography was performed in 80 patients (15.7 %). Indications for percutaneous coronary intervention for the LAD arose in 4 cases (0.8 %); the interventions were performed in the proximal (n = 2) or distal (n = 1) LAD and one intervention affected the anastomotic area. Redo CABG was necessary in 3 patients (0.5 %). Conclusions: Coronary reconstruction in patients with complex coronary morphology and advanced diffuse CAD is in an additionally investigated subgroup of patients associated with a satisfying graft patency and excellent long-term results in terms of survival, NYHA class and reintervention rate.

Key words

cardiovascular surgery - myocardial infarction - coronary bypass surgery

References

• 1 Carrel T P, Eckstein F S, Englberger L, Berdat P A, Schmidli J. Clinical experience with devices for facilitated anastomoses in coronary artery bypass surgery.  Ann Thorac Surg. 2004;  77 1110-1120
• 2 Osswald B R, Vahl C F, Hagl S. Increase of “high risk patients” undergoing CABG?.  Cardiovasc Engin. 1997;  2 228-230
• 3 Osswald B R, Tochtermann U, Schweiger P. et al . Target, application, and interpretation of scores and alternative methods for risk assessment in cardiac surgery.  Thorac Cardiovasc Surg. 2000;  48 72-78
• 4 Lemma M, Beretta L, Vanelli P, Santoli C. Open coronary endarterectomy, saphenous vein patch reconstruction, and internal mammary artery grafting.  Ann Thorac Surg. 1992;  53 1151-1152
• 5 Aranki S F. A modified reconstruction technique after extended anterior descending artery endarterectomy.  J Card Surg. 1993;  8 476-482
• 6 Livesay J J, Cooley D A, Hallman G L. et al . Early and late results of coronary endarterectomy. Analysis of 3369 patients.  J Thorac Cardiovasc Surg. 1986;  92 649-660
• 7 Sankar N M, Satyaprasad V, Rajan S, Bashi V V, Cherian K M. Extensive endarterectomy, onlay patch, and internal mammary bypass of the left anterior descending coronary artery.  J Card Surg. 1996;  11 56-60
• 8 Ladowski J S, Schatzlein M H, Underhill D J, Peterson A C. Endarterectomy, vein patch, and mammary bypass of the anterior descending artery.  Ann Thorac Surg. 1991;  52 1187-1189
• 9 Santini F, Casali G, Lusini M. et al . Mid-term results after extensive vein patch reconstruction and internal mammary grafting of the diffusely diseased left anterior descending coronary artery.  Eur J Cardiothorac Surg. 2002;  21 1020-1025
• 10 Takanashi S, Fukui T, Hosoda Y, Shimizu Y. Off-pump long onlay bypass grafting using left internal mammary artery for diffusely diseased coronary artery.  Ann Thorac Surg. 2003;  76 635-637
• 11 Abrahamov D, Tamaris M, Guru V. et al . Clinical results of endarterectomy of the right and left anterior descending coronary arteries.  J Card Surg. 1999;  14 16-25
• 12 Singh R N, Sosa J A. Internal mammary artery: a “live” conduit for coronary bypass.  J Thorac Cardiovasc Surg. 1984;  87 936-938
• 13 Walley V M, Byard R W, Keon W J. A study of the sequential morphologic changes after manual coronary endarterectomy.  J Thorac Cardiovasc Surg. 1991;  102 890-894
• 14 Ferraris V A, Harrah J D, Moritz D M, Striz M, Striz D, Ferraris S P. Long-term angiographic results of coronary endarterectomy.  Ann Thorac Surg. 2000;  69 1737-1743
• 15 Sundt 3rd T M. Reappraisal of coronary endarterectomy for the treatment of diffuse coronary artery disease.  Ann Thorac Surg. 1999;  68 1272-1277
• 16 Wallentin L, Swahn E, Kontny F. et al . Long-term low-molecular-mass heparin in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Fragmin and fast revascularisation during instability in coronary artery disease.  Lancet. 1999;  354 701-707
• 17 Cohen M, Adams P C, Parry G. et al . Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial.  Circulation. 1994;  89 81-88
• 18 Anand S S. The Organization to Assess Strategies for Ischemic Syndromes (OASIS) Pilot Study: evaluation of acute and long-term therapies for patients with acute coronary syndromes without ST elevation.  Am J Cardiol. 1999;  84 13M-19M
• 19 Djalilian A R, Shumway S J. Adjunctive coronary endarterectomy: improved safety in modern cardiac surgery.  Ann Thorac Surg. 1995;  60 1749-1754
• 20 Christakis G T, Rao V, Fremes S E, Chen E, Naylor C D, Goldman B S. Does coronary endarterectomy adversely affect the results of bypass surgery?.  J Card Surg. 1993;  8 72-78
• 21 Sergeant P, Blackstone E, Meyns B. Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important?.  J Thorac Cardiovasc Surg. 1998;  116 440-453
• 22 Beretta L, Lemma M, Vanelli P. et al . Coronary “open” endarterectomy and reconstruction: short- and long-term results of the revascularization with saphenous vein versus IMA-graft.  Eur J Cardiothorac Surg. 1992;  6 382-386
• 23 Osswald B R, Tochtermann U, Badowski-Zyla D, Thomas C, Hagl S. Coronary reconstructive surgery versus coronary artery bypass grafting - a documentation gap.  Thorac Cardiovasc Surg. 2006;  54 239-243