Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis

Abstract

OBJECTIVES The aim of this analysis was to compare survival outcomes of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with those of conventional CABG. METHODS Eight observational studies were included in this analysis, including 10 529 different patients in Asia, Europe and North America, from 1985 to 2012, among whom 1925 underwent CE + CAGB and 8604 underwent conventional CAGB. The follow-up period ranged from 4 to 14 years. This meta-analysis was performed with the fixed-effects model. RESULTS After rigorous assessment of the quality of the studies included, this analysis showed that CE + CABG had a statistically significant weaker short-term outcome, with a higher risk of mortality [odds ratio (OR)] 1.61; P = 0.002]. Further, this phenomenon was exacerbated in the midterm. One-year and 2-year results indicated that death was, respectively, 163% (OR 2.63; P < 0.001) and 133% (OR 2.60; P < 0.001) more likely to occur in the CE + CABG group. However, the long-term results indicated no difference between the 2 groups. The 4-year hazard ratio (1.13; P = 0.10) did not show significant differences between the groups, and the Kaplan–Meier survival curves had the same level and pattern. CONCLUSIONS CE + CABG had a significantly weaker short-term outcome than conventional CABG, and this trend continued in the midterm. The survival rate had the largest gap in the midterm. However, there was no significant difference between these 2 groups in the long run.

Midterm outcome of off‐pump CABG for severe LV dysfunction—Does LV size and function predict their midterm outcome?

“…Postoperative creatinine is being studied as a biomarker to predict long‐term outcomes after CABG 30 . The need for coronary endarterectomy in combination with severe LV dysfunction places these patients at high risk compared to those with good distal runoff and preserved ventricular function 31 …”

Venoarterial extracorporeal membrane oxygenation for cardiogenic shock after coronary endarterectomy

“…According to several reports, CABG with CE was associated with a higher incidence of MI as compared to isolated CABG. 16,17 Despite improvements in surgical techniques, CE causes mechanical trauma to the coronary vessel, resulting in a loss of endothelial integrity and function. Moreover, CE might also lead to athero-emboli and even produce intimal tears within the coronary vessel.…”

Gas Exchange Mechanism of High Frequency Ventilation: A Brief Narrative Review and Prospect

“…Additionally, the HFV also prevents the ventilation induced lung injury (VILI) by reducing the risk of volutrauma. And by reducing the mean airwaypressure [11][12][13][14][15] , the HFV as well is beneficial to increasing cardiac output and to alleviating the harmful effect on arterial blood. Especially for neonates with severe ARDS, the early application of HFV is more helpful to improve the curative effect of the ventilation [16][17][18] .…”