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      Outcome of coronary endarterectomy with coronary artery bypass grafting in patients with diffuse coronary artery disease in Bangladesh: A retrospective cohort study

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          Abstract

          Background

          In this study, we aimed to review the consequences of coronary endarterectomy with coronary artery bypass grafting, and assess outcomes of this combined surgical technique for patients with diffuse coronary artery disease in a single surgeon’s practice.

          Methods

          We retrospectively reviewed outcome of 1198 endarterectomized coronary artery in 1000 patients with diffuse coronary artery disease, who have had experienced coronary endarterectomy with off pump coronary artery bypass grafting in between 2009 and 2016.

          Results

          The mean age was 61.5 ± 5.5 years. Coronary endarterectomy was performed on 74.7% in the left coronary territory (43.2% left anterior descending, 26.6% diagonal, 4.9% Obtuse Marginal), and 25.3% in the right coronary territory. Post-operative intensive care unit mortality rate was 1.9%, and there were 11 (1.1%) late deaths. Mean intensive care unit stay was 36.6 ± 6.7 hours. Patients were extubated following a mean of 9.8 ± 1.25 hours. The mean duration of hospital stay was 10 ± 1 days. One-year survival rate was 97.8% and 89.5% survival rate was at 5 years follow up. However, 91.8% of patients were angina free at median follow-up of 2.5 years.

          Conclusion

          Coronary endarterectomy with off pump coronary artery bypass grafting is attainable and accomplishes surgical revascularization in coronary artery disease patients when there is no other alternative for sufficient revascularization.

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          Most cited references22

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          Does off-pump coronary surgery reduce morbidity and mortality?

          Joseph F Sabik, José A. Navia, A. Marc Gillinov … (2002)
          To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery. From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P =.9), left ventricular function (P =.7), extent of coronary artery disease (P =.5), carotid artery disease (P =.4), and chronic obstructive pulmonary disease (P =.5). However, off-pump patients had more previous strokes (P =.05) and peripheral vascular disease (P =.02); on-pump patients had a higher preoperative New York Heart Association class (P =.01). In the matched pairs the mean number of bypass grafts was 2.8 +/- 1.0 in off-pump patients and 3.5 +/- 1.1 in on-pump patients (P <.001). Fewer grafts were performed to the circumflex (P <.001) and right coronary (P =.006) artery systems in the off-pump patients. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups. There was more encephalopathy (P =.02), sternal wound infection (P =.04), red blood cell use (P =.002), and renal failure requiring dialysis (P =.03) in the on-pump patients. Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass.
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            Survival after coronary endarterectomy in man.

            C BAILEY, A. May, W M LEMMON (1957)
            Article 0 comments Cited 21 times – based on 0 reviews     Review now
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              Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients.

              Sharif Al-Ghazal, Charles Ilsley, Thomas Modine … (2002)
              Although there has been some evidence supporting the theoretical and practical advantages of off-pump coronary artery bypass (OPCAB) over the conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), it has not yet been determined which group of patients would benefit most from it. It has been advocated recently that high-risk patients could benefit most from avoidance of CPB. The aim of this retrospective study is to assess the efficacy of the OPCAB technique in multi-vessel myocardial revascularization in a large series of high-risk patients. The records of 1398 consecutive high-risk patients who underwent primary isolated CABG at Harefield Hospital between August 1996 and December 2001 were reviewed retrospectively. Patients were considered as high-risk and included in the study if they had a preoperative EuroSCORE of > or =5. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The OPCAB patients were significantly older than the CPB patients (68.1+/-8.3 vs. 63.7+/-9.9 years, respectively, P<0.001). The OPCAB group included significantly more patients with poor left ventricular (LV) function (ejection fraction (EF) < or =30%) (P<0.001) and more patients with renal problems (P<0.001). There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8+/-1.2 grafts per patient while OPCAB patients received 2.8+/-0.5 grafts per patient (P=1). Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P=0.008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative myocardial infarction (MI) while only two (0.7%) OPCAB patients developed peri-operative MI (P=0.024). The intensive therapy unit (ITU) stay for OPCAB patients was 29.3+/-15.4 h while for CPB patients it was 63.6+/-167.1 h (P<0.001). There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P=0.041) within 30 days postoperatively. This retrospective study shows that using the OPCAB technique for multi-vessel myocardial revascularization in high-risk patients significantly reduces the incidence of peri-operative MI and other major complications, ITU stay and mortality. Even though the OPCAB group included a significantly higher proportion of older patients with poor LV function (EF < or =30%) and renal problems, the beneficial effect of OPCAB was evident.
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                Author and article information

                Journal
                Journal ID (nlm-ta): JRSM Cardiovasc Dis
                Journal ID (iso-abbrev): JRSM Cardiovasc Dis
                Journal ID (publisher-id): CVD
                Journal ID (hwp): spcvd
                Title: JRSM Cardiovascular Disease
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 2048-0040
                Publication date (Electronic): 20 September 2017
                Publication date Collection: Jan-Dec 2017
                Volume: 6
                Electronic Location Identifier: 2048004017732658
                Affiliations
                [1 ]Department of Cardiac Surgery, Ringgold 74464, universityBangabandhu Sheikh Mujib Medical University (BSMMU); , Dhaka, Bangladesh
                [2 ]Al Helal Specialized Hospital, Dhaka, Bangladesh
                [3 ]Department of Community medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
                [4 ]Ringgold 4212, universityKeele University; , UK
                Author notes
                [*]Redoy Ranjan, Department of Cardiac surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Email: redoy_ranjan@ 123456yahoo.com
                Author information
                http://orcid.org/0000-0002-5327-7471
                Article
                Publisher ID: 10.1177_2048004017732658
                DOI: 10.1177/2048004017732658
                PMC ID: 5613798
                PubMed ID: 28975025
                SO-VID: c42f1c82-8222-46a3-a736-f09cb40fadf6
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 17 July 2017
                Date revision received : 24 August 2017
                Date accepted : 29 August 2017
                Categories
                Subject: Research Paper
                Custom metadata
                cover-date January-December 2017

                Keywords: coronary endarterectomy,coronary artery disease,coronary artery bypass graft
                Data availability:
                Keywords: coronary endarterectomy, coronary artery disease, coronary artery bypass graft

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