Long-term outcomes of reconstructive procedures on coronary arteries for diffuse coronary atherosclerosis without endarterectomy

Abstract

Objective. This study evaluated the long-term clinical and angiographic outcomes of coronary artery reconstruction for a diffusely diseased coronary artery without endarterectomy.Material and Methods. We retrospectively reviewed 660 consecutive patients (mostly men (89.5%), mean age 68.3 ± 7.4 years) who underwent coronary artery bypass grafting in combination with coronary artery reconstruction between 2003 and 2016. 558 operated on patients (84.5%) were followed up for a mean of 94.3 ± 31.2 months.Results. Long-term survival was 83.2% (95% confidence interval: 74.5–89.3); freedom from cardiac death was 97.4 ± 1.2%; and freedom from major adverse cardiac and cerebrovascular events was 64.7 ± 4.1%. Independent predictors of long-term mortality were age at surgery (< 70 years, p < 0.001), chronic obstructive pulmonary disease (p = 0.007), peripheral arterial disease (p = 0.002), diabetes mellitus (p = 0.013) and chronic kidney disease (p = 0.034). The arterial graft patency rate was 95.2%, and the vein graft patency rate was 75.4%.Conclusion. Coronary artery bypass grafting in conjunction with coronary artery reconstruction without endarterectomy confers satisfactory long-term clinical outcomes with high probability of freedom from cardiac death and angina pectoris, good rates of angiographic patency of arterial grafts and favorable rates of vein graft patency.

Keywords

• coronary artery reconstruction
• diffuse coronary atherosclerosis
• left internal mammary artery
• graft patency