title: [Off-pump Coronary Artery Bypass Grafting with Concomitant Coronary Endarterectomy for the Diffusely Diseased Coronary Artery].
abstract: Recent progress in percutaneous coronary intervention has driven more patients with complex or diffuse coronary artery disease to be referred for surgical revascularization. Coronary endarterectomy (CE) is a treatment option for diffusely diseased coronary arteries. On the other hand, off-pump coronary artery bypass grafting (off-pump CABG) has currently been the standard procedure for surgical revascularization in patients with coronary artery disease. We performed off-pump CABG with concomitant CE for the diffusely diseased left anterior descending artery( LAD) for 194 patients from September 2004 to August 2015. Mean age was 66.5±8.9 years and 168 were male. Mean preoperative ejection fraction was 54.9±12.4%. Mean length of arteriotomy in the LAD was 6.1±1.9 cm and endarterectomized LAD was reconstructed using the internal thoracic artery (ITA) with an onlay-patch fashion in all patients. On-pump conversion was required in 13( 6.7%) patients. 17( 8.8%) patients suffered from perioperative myocardial infarction. The 30-day mortality was 1.0 %.Patency rate of the reconstructed LAD at early postoperative angiography was 93.3%( 181/194). In summary, CE with onlay-patch grafting using the ITA for the diffusely diseased LAD with an off-pump technique can be performed safely with satisfactory outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nishigawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome