Previous Stenting Doesn’t Affect Outcome of Extensive Endarterectomy for Diffuse Coronary Artery Total Occlusions: A Propensity Score Matching Analysis
Extensive Endarterectomy for diffuse Coronary Artery Total Occlusions
Keywords:coronary occlusions, Coronary endarterectomy, left anterior descending artery
Background and aim: Extensive diffuse coronary artery total occlusions (CTOs) constitute a challenging surgical problem. Extensive coronary endarterectomy (CE) combined with CABG was suggested as a revascularization technique. It was claimed that previous stenting may affect outcome. The present study aimed to report the outcome of LAD endarterectomy for CTO and to determine the effect of previous stenting on this outcome.
Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay, and mortality.
Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9% versus 89.1%; P = .27), graft survival (median [95% CI]: 134.3 months [127.0-141.5] versus 135.2 months [128.4-142.0]; P = .35), patients’ survival (93.9% versus 91.4%) and patients’ survival time (median [95% CI]: 132.3 months [125.0-139.5] versus 138.0 months [132.0-144.1]; P = .75].
Conclusion: The present study supports using CE as an adjuvant technique with CABG in patients with TCOs.
Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay and mortality.
Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9 % versus 89.1; p=0.27), graft survival [median (95% CI): 134.3 months (127.0-141.5) versus 135.2 months (128.4-142.0); p=0.35], patients’ survival (93.9 % versus 91.4 %) and patients’ survival time [median (95% CI): (132.3 months (125.0-139.5) versus 138.0 months (132.0-144.1); p= 0.75].
Conclusions: The present study supports use CE as an adjuvant technique with CABG in patients with TCOs.
Allahwala UK et al. 2019. Indications for percutaneous coronary intervention (PCI) in chronic total occlusion (CTO): have we reached a DECISION or do we continue to EXPLORE after EURO-CTO? Heart, Lung and Circulation 28:1484-9.
Anantha-Narayanan M, Garcia S. 2019. Contemporary approach to chronic total occlusion interventions. Current Treatment Options in Cardiovascular Medicine 21:1.
Binsalamah ZM et al. 2014. Mid‐Term outcome and angiographic follow‐up of endarterectomy of the left anterior descending artery in patients undergoing coronary artery bypass surgery. J Cardiac Surg: Including Mechanical and Biological Support for the Heart and Lungs 29:1-7.
Brilakis ES et al. 2016. Update on coronary chronic total occlusion percutaneous coronary intervention. Interventional Cardiology Clinics 5:177-86.
Byrne JG et al. 2004. Left anterior descending coronary endarterectomy: early and late results in 196 consecutive patients. Ann Thoracic Surg 78:867-73.
Dash D. 2016. Complications encountered in coronary chronic total occlusion intervention: prevention and bailout. Indian heart journal 68:737-46.
El-Gamel A, Chan B. 2020. Full metal jacket endarterectomy of left anterior descending coronary artery is safe with good midterm outcomes. Heart Lung Circ S1443-9506:30439-X.
Fukui T, Takanashi S, Hosoda Y. 2005. Coronary endarterectomy and stent removal in patients with in-stent restenosis. Ann Thorac Surg 79:558-63.
Katselis C et al. 2017. Outcomes after a left anterior descending artery endarterectomy in advanced coronary artery disease. Cardiovascular Revascularization Medicine 18:332-7.
Khatri J, Abdallah M, Ellis S. 2017. Management of coronary chronic total occlusion. Cleve Clin J Med 84:27-38.
Koelbl CO, Nedeljkovic ZS, Jacobs AK. 2018. Coronary chronic total occlusion (CTO): a review. Reviews in cardiovascular medicine 19:33-9.
Massoudy P et al. 2009. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis. J Thorac Cardiovasc Surg 137:840-5.
Myers PO et al. 2012. Extensive endarterectomy and reconstruction of the left anterior descending artery: early and late outcomes. J Thorac Cardiovasc Surg 143:1336-40.
Nardi P et al. 2018. Coronary endarterectomy: an old tool for patients currently operated on with coronary artery bypass grafting. Long-term results, risk factor analysis. Kardiochirurgia i Torakochirurgia Polska (Polish Journal of Cardiothoracic Surgery) 15:219.
Nemati MH, Astaneh B, Khosropanah S. 2015. Outcome and graft patency in coronary artery bypass grafting with coronary endarterectomy. Korean J Thorac Cardiovasc Surg 48:13.
Nishigawa K et al. 2017. Ten-year experience of coronary endarterectomy for the diffusely diseased left anterior descending artery. Ann Thorac Surg 103:710-16.
Nurozler F et al. 2006. Off-pump coronary endarterectomy in high-risk patients. Asian Cardiovasc Thoracic Ann 14:227-30.
Qiu Z et al. 2014. Comparison of off-pump and on-pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome. J Cardiothorac Surg 9:1-8.
Sachweh J et al. 2007. Left anterior descending coronary artery: long-term angiographic results of CABG with endarterectomy. J Cardiovasc Surg 48:633.
Sathananthan J, Džavík V. 2017. Coronary intervention for chronic total occlusion: current indications and future directions. Coronary artery disease 28:426-36.
Song Y et al. 2017. Coronary endarterectomy with coronary artery bypass graft decreases graft patency compared with isolated coronary artery bypass graft: a meta-analysis. Interactive Cardiovasc Thorac Surg 25:30-6.
Stavrou A et al. 2016. Coronary endarterectomy: the current state of knowledge. Atherosclerosis 249:88-98.
Takahashi M et al. 2013. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interactive cardiovascular and thoracic surgery. 16:301-5.
Vohra HA et al. 2006. Early and late outcome after off-pump coronary artery bypass graft surgery with coronary endarterectomy: a single-center 10-year experience. Ann Thorac Surg 81:1691-6.
Wang J et al. 2015. 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) 94:e1781.
Wang C et al. 2019. Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis. Interactive cardiovascular and thoracic surgery. 29:393-401.
Weintraub WS, Garratt KN. 2016. Should chronic total occlusion be treated with coronary artery bypass grafting? Chronic total occlusion should not routinely be treated with coronary artery bypass grafting. Circulation 133:1818-25.
Zakkar M, George SJ, Ascione R. 2016. Should chronic total occlusion be treated with coronary artery bypass grafting? Chronic total occlusion should be treated with coronary artery bypass grafting. Circulation 133:1807-16.
Zhu P et al. 2019. Does the site of coronary endarterectomy have an impact on the clinical outcomes and graft patency? Interactive Cardivasc Thorac Surg 29:402-8.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).