Off-Pump Coronary Endarterectomy in High-Risk Patients

Nurozler, Feza; Kutlu, Tolga; Kucuk, Gungor; Ökten, Candan Cudi

doi:10.1177/021849230601400312

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…Nurozler et al [8] retrospectively studied 32 patients undergoing OPCAB-CE with moderate ventricular impairment (ejection fraction (EF) 38.6%). The mean number of CEs performed per patient was 1.18 ± 0.2.…”

Section: Resultsmentioning

confidence: 99%

“…Among these best evidence series, the overall incidence of postoperative MI was 6.1% (11/180). Increased incidence of postoperative MI was particularly notable in patients undergoing multiple endarterectomies [3,6], RCA endarterectomy [8] and endarterectomy performed using a closed approach [6,8]. Notably, however, MI rates were comparable between OPCAB and ONCAB techniques [5,7].…”

Section: Clinical Bottom Linementioning

confidence: 99%

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Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy?: Table 1:

Soylu

Harling

Ashrafian

et al. 2014

Interact CardioVasc Thorac Surg

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass grafting with coronary endarterectomy (OPCAB-CE) is a safe and feasible method of myocardial revascularization in patients presenting with diffuse coronary artery disease. Seventy-one papers were identified by a systematic search, of which nine were judged to best answer the clinical question. All were observational studies. Of these, two were comparative and the remaining seven were case series. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results were tabulated. In total, these 9 studies included 341 patients (225 OPCAB-CE, 116 ONCAB-CE) undergoing coronary endarterectomy in combination with coronary artery bypass grafting. CE was performed either by an open method whereby the atheroma is removed through an arteriotomy made along the length of the stenosis or by a closed method whereby the atheroma is removed by gentle traction through a small arteriotomy made over a proximal area of the plaque. Overall, OPCAB-CE was associated with a low perioperative mortality ranging from zero in smaller case series to 2.8% in the largest study (n = 70). Two comparative studies demonstrate at least equivalent 30-day mortality between OPCAB-CE and ONCAB-CE, although the sample sizes are small. The overall incidence of postoperative myocardial infarction (MI) was 6.1% (11/180) and seems comparable between OPCAB-CE and ONCAB-CE. Notably, both postoperative MI and mortality appeared higher in patients undergoing multiple endarterectomies performed using a closed technique and CE to the right coronary artery was associated with increased postoperative MI. In summary, OPCAB-CE in the setting of diffuse coronary artery disease appears both safe and feasible, yielding comparable results to ONCAB-CE. Where possible, open arteriotomy with on-lay patch angioplasty may improve postoperative outcomes. Large, prospective database studies are now required with explicit sub-group criteria and stratification to number, territory and technique of endarterectomy in order to isolate the patients in whom OPCAB-CE may confer the greatest benefit.

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Bottom Linementioning

confidence: 99%

Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy?: Table 1:

Soylu

Harling

Ashrafian

et al. 2014

Interact CardioVasc Thorac Surg

View full text Add to dashboard Cite

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“…Vohra et al 28 reported 4.3% for the postoperative MI rate. Nurozler et al 31 reported a perioperative MI rate of 6.2%. In both of these studies, off-pump technique was used for CE and the majority had single vessel CE to RCA.…”

Section: Discussionmentioning

confidence: 98%

Comparing short and long term survival of patients undergoing off pump coronary artery bypass graft with and without coronary endarterectomy

Sabzi

Asadmobini

Rezaei

2017

Indian Heart Journal

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Background and aimThere is some controversy about survival of coronary endarterectomy (CE) patients, so the current study aims to compare short and long term survival of patients undergoing off pump coronary artery bypass graft (OPCAB) with and without coronary endarterectomy.Patients and methodswe performed a retrospective analysis of data on patients undergoing OPCAB and CE between 2011 and 2012. Preoperative, perioperative and postoperative data collected from data bank. Follow-up information was obtained from telephone contact mean time 37.13 ± 23.82 months after surgery. Early and late outcomes were compared by univariate and Kaplan-Meier analysis.ResultOPCAB was performed in 474 patients, which 69 of them had a CE. The mean long term survival was similar between OPCAB (56.28 ± 0.61) and OPCAB + CE (55.54 ± 1.3) groups (p = 0.66). Multiple Cox regression shows that age, gender, BMI, EF and angina were significant predictors of mortality. Patients undergoing CE have a long term intensive care unit (ICU) stay (51.31 ± 5.59 vs 37.23 ± 0.88, P = 0.015) and blood transfusion was higher in CE group (650.62 ± 110 vs. 324.71 ± 22, P = 0.001).ConclusionThe current study demonstrates that results of CE are acceptable with respect to short and long -term survival. Patients undergoing CE required long term ICU stay and higher blood transfusion.

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“…The majority (65%) of patients in our study had on-pump CABG, although we feel that CE is easier to perform off-pump, as reported by Vohra and colleagues; 9 however, the results were similar in off-pump and on-pump cases. Nurozler and colleagues 13 reported a perioperative MI rate of 6.2% and overall mortality of 3.1% at 14 AE 3.3 months. In both these studies, off-pump CE was mostly to the right coronary artery only.…”

Section: Discussionmentioning

confidence: 98%

Hospital Outcome of Coronary Artery Bypass Grafting and Coronary Endarterectomy

Abid

Farogh

Naqshband

et al. 2009

Asian Cardiovasc Thorac Ann

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To compare hospital mortality and postoperative complications in patients with severe coronary artery disease undergoing coronary artery bypass grafting with or without coronary endarterectomy, 100 consecutive patients were divided into 2 groups of 50 patients each. Group 1 had coronary endarterectomy, and group 2 had no coronary endarterectomy. There were 87 men and 13 women, with a mean age of 54.79 +/-7.8 years; 48% had stable angina. The right coronary artery was endarterectomized in 22 patients, the left anterior descending artery in 21, and the left circumflex in 7. There were no significant differences in outcomes. There was 1 hospital death in each group. Perioperative myocardial infarction occurred in 2 patients in group 1 and 1 in group 2. Endarterectomy is a suitable option to achieve complete revascularization in patients with refractory angina and severe diffuse disease.

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Off-Pump Coronary Endarterectomy in High-Risk Patients

Cited by 9 publications

References 17 publications

Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy?: Table 1:

Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy?: Table 1:

Comparing short and long term survival of patients undergoing off pump coronary artery bypass graft with and without coronary endarterectomy

Hospital Outcome of Coronary Artery Bypass Grafting and Coronary Endarterectomy

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