Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.
ObjectiveTo investigate surgical treatment strategies for diffuse coronary artery disease (CAD). MethodsFrom January 2003 to June 2013, 92 patients with diffuse CAD received complete coronary revascularization including coronary artery bypass grafting (CABG)and coronary endarterectomy (CE)in the First Affiliated Hospital of China Medical University. There were 63 male and 29 female patients with their age of 52-81 (68.7±10.5)years. After CE and during follow-up, coronary CT angiography (CTA)was used to assess graft patency, and improvement of patients' cardiac function and angina symptoms were observed. ResultsTarget vessel diameter of the 92 patients was all larger than 1.5 mm after CE. Sixty-three patients (with 69 CE grafts)received intraoperative graft blood flow measurement, showing 59 grafts (85.5%)with satisfactory blood flow[blood flow 13-42 (23.4±12.7)ml/min, pulsatility index (PI)1.6-4.2 (2.1±1.1)]. Six patients (6.5%)had perioperative myocardial infarction (MI), and 4 patients (4.3%)died within 30 days after surgery including 2 patients with acute MI and cardiogenic shock, 1 patient with low cardiac output syndrome and multiple organ failure, and 1 patient with massive cerebral infarction. Seventy-three patients (83%)were followed up for 6-108 (49.3±26.7)months after discharge, and 15 patients were lost during follow-up. During follow-up, coronary CTA showed graft patency of 83.9% after CE. Four patients (5.5%)died including 1 patient with heart failure and pulmonary infection, 1 patient of unexplained sudden death, 1 patient with cerebral hemorrhage, and 1 patient with lung cancer. Five-year survival rate was 87% after CE. Six months after CE, ejection fraction (EF)was significantly higher than preo-perative EF (55.6%±9.7% vs. 50.2%±10.5%, P < 0.05), patients' cardiac function significantly improved, and their angina symptoms were significantly relieved. ConclusionCABG with CE can improve coronary revascularization for patients with diffuse CAD, and short-and long-term results are satisfactory.
ObjectiveTo compare the perioperative and mid-term follow-up outcomes of patients undergoing coronary endarterectomy combined with coronary artery bypass grafting (CE-CABG) versus those undergoing CABG alone. MethodsA retrospective cohort of 2 070 patients who underwent surgery for coronary artery disease at the Department of Cardiac Surgery, Guangdong Provincial People's Hospital between 2016 and 2024 was included. Patients were excluded if they had missing data, concomitant valve, aortic, or congenital heart surgery, or underwent off-pump CABG. Eligible patients were divided into a CE-CABG group and a CABG group, and 1 : 1 propensity score matching was performed using the "MatchIt" package in R software. ResultsA total of 202 patients were included after matching (172 males, 30 females), with a mean age of (60.3±7.5) years. Baseline characteristics were well-balanced between the two groups (standardized mean difference<0.1 for all covariates). There were no statistical differences in operative mortality (4.0% vs. 4.0%) or early postoperative major adverse cardiovascular and cerebrovascular events (MACCE) (4.0% vs. 5.0%, both P >0.05) between the CE-CABG and CABG groups. The CE-CABG group exhibited significantly prolonged operative time [(401.1±105.9) min vs. (353.3±95.6) min], cardiopulmonary bypass (CPB) time [(206.4±65.2) min vs. (174.6±63.1) min], aortic cross-clamp time [125.0 (101.0, 159.5) min vs. 93.0 (70.0, 126.0) min] and postoperative hospital stay [24.0 (18.5, 33.5) d vs. 21.0 (15.0, 28.0) d] (all P<0.05). During a median follow-up of 33 months (follow-up rate: 93.1%), no statistical differences were observed in all-cause mortality (3.0% vs. 5.5%, P=0.498) or MACCE incidence (14.9% vs. 16.8%, P=0.700) between the two groups. However, the rates of cardiac-related readmission (23.8% vs. 37.6%, P=0.033) and coronary angiography re-examination (13.9% vs. 27.7%, P=0.015) were significantly lower in the CE-CABG group. Conclusion CE-CABG facilitates complete revascularization in patients with diffuse coronary artery disease (DCAD) without increasing operative mortality or the incidence of MACCE. CE-CABG is associated with longer CPB time, aortic cross-clamp time, operative time, and postoperative hospital length of stay. Follow-up results indicate that CE-CABG reduces the rates of cardiac-related readmission and coronary angiography re-examination in patients with DCAD. These findings demonstrate that the CE procedure itself does not increase operative risk and serves as a safe and effective strategy for achieving complete revascularization in patients with DCAD.