Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

Objectives preliminary experience on endarterectomy and To summarize our off-pump coronary bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3year period, 53 patients （41 male） with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution. Patients＇ age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 （n=5） or 3 （n=32）, and nearly half of them （26/53） had history of myocardial infarction. Most patients （n= 50） had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% （mean 52%）. At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery （LAD）, 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery （LIMA） grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries, and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of complet-eness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay （mean duration = 9 days）. Intra-operatively, 63 （90%） out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative neither experienced signifi myocardial infarctions but cant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be coronary improve zation. performed safely in patients with diffuse artery disease. This strategy may help to the completeness of myocardial revasculariation.

Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. Coronary endarterectomy （CE） offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft （CABG） was discussed in the treatment for the diffused CAD. Methods： From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE ＋ CABG were pertbrmed, which was about 17.2% （38/221） of the cohort. All these patients were divided into two groups： CE ＋ CABG group （Group A） and CABG alone group and postoperative complications and in-hospital mortality were Chi-square test and Student＇s t-test respectively. （Group B）. All clinical data were compared between the two groups, analyzed. The categorical and continuous variables were analyzed by Results： Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was perfbrmed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A （3/38）, which was more often than that in Group B （3/183）. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent （50/50）. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions： Coronary endarterectomy ＋ CABG can oilier satisfactory result for patients with diffused CAD in a short-term after the operation.

Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

Currently coronary artery bypass grafting （CABG） is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft （CVBG）,