Frequency of Coronary Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting at a Single Tertiary Texas Hospital 2010 to 2016 With Morphologic Studies of the Operatively Excised Specimens

Roberts, William C.; Berry, Anna E.

doi:10.1016/j.amjcard.2017.09.002

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…According to Fernandez et al [29], excimer coronary laser atherectomy (ECLA) is useful in patients with diffuse coronary artery disease but is not effective when total occlusion is present [12]. It may be more accurate to refer to it as endarterectomy because pathologic and autopsy studies include the muscle layer in endarterectomy materials [15]. Additional CE may not be useful in this study [15].…”

Section: Discussionmentioning

confidence: 96%

“…It may be more accurate to refer to it as endarterectomy because pathologic and autopsy studies include the muscle layer in endarterectomy materials [15]. Additional CE may not be useful in this study [15]. Previous studies have reported that brin deposits accumulate rapidly on the endarterectomized surface.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that brin deposits accumulate rapidly on the endarterectomized surface. These brin deposits form a uniform brous tissue and often lead to severe or complete occlusions in the lumen of the coronary artery [15]. Open stent endarterectomy is a valuable alternative option for patients with "full metal jacket" diseased LAD, which cannot be transplanted with acceptable mid-term results using standard techniques [30].…”

Section: Discussionmentioning

confidence: 99%

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Experiences of the Coronary Endarterectomy with Closed Technique in Coronary Artery Bypass Surgery

Ertürk,

Reyhanoğlu,

Özcan

et al. 2023

Preprint

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Background Coronary artery bypass grafting (CABG) with coronary artery endarterectomy (CE) is a necessary and effective alternative procedure for complete vascularization in diffuse and severe coronary artery disease. The mid- to long-term outcomes of CE remain highly controversial. The aim of this study is to compare the results of closed-technique CABG CE with those of other recently published articles. Methods In this prospective study, 6000 patients underwent standard coronary artery bypass grafting between August 2004 and August 2014. Approximately 3.2% of these patients, or a total of 193 patients, underwent CE as part of this surgery. A closed-technique was performed in all patients who underwent CE. Results The perioperative myocardial infarction and postoperative morbidity of patients who underwent the closed-technique CE remained unchanged; however, the mortality rate of these patients compared with the open technique CE was lower than that reported in the current literature. In addition, the closed- technique is a highly advantageous technique. It is considered an overall safe procedure because the anastomosis time is short and minimal cross-clamp time when compared with the open technique CE. Conclusion The closed-technique CE should be considered an adequate, safe surgical procedure and a good alternative choice for complete revascularization in suitable patients. Furthermore, the closed-technique CE is a safe operation for the patient with excellent survival rates and graft patency rates. In a select group of patients, perioperative and postoperative mortality and morbidity are not high when the procedure is performed by an experienced team of OR.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experiences of the Coronary Endarterectomy with Closed Technique in Coronary Artery Bypass Surgery

Ertürk,

Reyhanoğlu,

Özcan

et al. 2023

Preprint

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“…4 Although CE improves the patency of the diffusely diseased coronary artery, the procedure may shear off and obstruct the numerous smaller branches that supply the myocardium. 22 In addition, the media and the intima of coronary was removed, resulting in a loss of endothelial integrity and function. Moreover, CE can also produce intimal tears within the coronary vessel.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of coronary artery bypass grafting with coronary endarterectomy: A systematic review and meta-analysis of recent studies

Zhang

2022

Perfusion

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Objective: The aim of this systematic review and meta-analysis was to evaluate the short-term and long-term outcomes of coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) versus isolated CABG. Methods: Studies evaluating outcomes of CABG with CE (CE-CABG) were searched from 1 January 2000 to 30 September 2022, on PubMed, Embase, and Cochrane databases. The primary outcome was 30 -days mortality. Secondary outcomes were postoperative myocardial infraction, low output syndrome, cardiac arrhythmia, renal dysfunction, and 5 years survival. Results: A total of 12 observational studies including 114,319 patients assessing CE-CABG ( n = 35,174) versus isolated CABG ( n = 79,145) were included. Compared to isolated CABG alone, CE-CABG was significantly associated with increased incidences of 30-days mortality (RR, 1.87; 95% CI, 1.73–2.07; p < 0.01), postoperative myocardial infraction (RR, 1.61; 95% CI, 1.26–2.05; p < 0.01), low output syndrome (RR, 1.54; 95% CI, 1.17–2.02; p < 0.01), and renal dysfunction (RR, 1.56; 95% CI, 1.44–1.69; p < 0.01). However, there was no difference in either rate of cardiac arrhythmia (RR, 1.06; 95% CI, 0.97–1.15; p = 0.20) or 5 years survival (RR, 1.05; 95% CI, 0.95–1.16; p = 0.34) between the CE-CABG group and the control group. Subgroup analysis on CE technique showed that CE-CABG was also associated with 30 days mortality in patients undergoing closed CE (RR, 1.49; 95% CI, 1.09–2.03), whereas this association between CE and 30 days mortality was not observed in patients undergoing open CE (RR, 1.76; 95% CI, 0.58–5.32). Conclusions: Despite poor short-term outcomes, CE-CABG appeared to offer satisfactory long-term survival in patients with diffuse coronary artery disease.

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“…These patients mainly experience graft occlusion owing to thrombosis in endarterectomized regions. During endarterectomy, the vascular intima is carefully dissected and removed, which exposes the subendothelial tissue to blood flow, causing fibrin platelet mural thrombus and activation of the coagulation cascade [ 6 – 8 ]. Dual antiplatelet therapy (DAPT) and postoperative anticoagulation may play a role in avoiding POMI after CE-CABG.…”

Section: Introductionmentioning

confidence: 99%

Early tirofiban versus heparin for bridging dual antiplatelet therapy in patients undergoing coronary endarterectomy combined with coronary artery bypass grafting: a multicenter randomized controlled trial protocol (the THACE-CABG trial)

Chen,

Gao,

et al. 2024

Trials

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Background For complete revascularization, patients with diffuse coronary artery disease should have a coronary endarterectomy and a coronary artery bypass graft (CE-CABG). Sadly, CE can lead to a lack of endothelium, which raises the risk of thrombotic events. Even though daily dual antiplatelet therapies (DAPT) have been shown to reduce thrombotic events, the risk of perioperative thrombotic events is high during the high-risk period after CE-CABG, and there is no consistent protocol to bridge DAPT. This trial aims to compare safety and efficacy between tirofiban and heparin as DAPT bridging strategies after CE-CABG. Methods In phase I, 266 patients undergoing CE-CABG will be randomly assigned to tirofiban and heparin treatment groups to compare the two treatments in terms of the primary safety endpoint, chest tube drainage in the first 24 h. If the phase I trial shows tirofiban non-inferiority, phase II will commence, in which an additional 464 patients will be randomly assigned. All 730 patients will be studied to compare major cardiovascular and cerebrovascular events (MACCEs) between the groups in the first 30 days after surgery. Discussion Given the possible benefits of tirofiban administration after CE-CABG, this trial has the potential to advance the field of adult coronary heart surgery. Trial registration chictr.org.cn, ChiCTR2200055697. Registered 6 January 2022. https://www.chictr.org.cn/com/25/showproj.aspx?proj=149451. Current version: 20,220,620.

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Frequency of Coronary Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting at a Single Tertiary Texas Hospital 2010 to 2016 With Morphologic Studies of the Operatively Excised Specimens

Cited by 7 publications

References 15 publications

Experiences of the Coronary Endarterectomy with Closed Technique in Coronary Artery Bypass Surgery

Experiences of the Coronary Endarterectomy with Closed Technique in Coronary Artery Bypass Surgery

Outcomes of coronary artery bypass grafting with coronary endarterectomy: A systematic review and meta-analysis of recent studies

Early tirofiban versus heparin for bridging dual antiplatelet therapy in patients undergoing coronary endarterectomy combined with coronary artery bypass grafting: a multicenter randomized controlled trial protocol (the THACE-CABG trial)

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