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

Authors

  • Hamdy Singab, PhD Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo
  • Gamal Sami, PhD Cardiothoracic Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt

DOI:

https://doi.org/10.1532/hsf.3473

Keywords:

coronary occlusions, Coronary endarterectomy, left anterior descending artery

Abstract

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.

References

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.

Published

2021-03-04

How to Cite

Singab, H., & Sami, G. (2021). 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. The Heart Surgery Forum, 24(2), E243-E248. https://doi.org/10.1532/hsf.3473

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