Singab Hamdy, Sami Gamal
Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cardiothoracic Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt.
Heart Surg Forum. 2021 Mar 4;24(2):E243-E248. doi: 10.1532/hsf.3473.
Extensive diffuse coronary artery total occlusions (CTOs) constitute a challenging surgical problem. Extensive coronary endarterectomy (CE) combined with CABG was suggested as a revascularization technique. It was claimed that previous stenting may affect outcome. The present study aimed to report the outcome of LAD endarterectomy for CTO and to determine the effect of previous stenting on this outcome.
The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay, and mortality.
Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9% versus 89.1%; P = .27), graft survival (median [95% CI]: 134.3 months [127.0-141.5] versus 135.2 months [128.4-142.0]; P = .35), patients' survival (93.9% versus 91.4%) and patients' survival time (median [95% CI]: 132.3 months [125.0-139.5] versus 138.0 months [132.0-144.1]; P = .75].
The present study supports using CE as an adjuvant technique with CABG in patients with TCOs. Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay and mortality. Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9 % versus 89.1; p=0.27), graft survival [median (95% CI): 134.3 months (127.0-141.5) versus 135.2 months (128.4-142.0); p=0.35], patients' survival (93.9 % versus 91.4 %) and patients' survival time [median (95% CI): (132.3 months (125.0-139.5) versus 138.0 months (132.0-144.1); p= 0.75]. Conclusions: The present study supports use CE as an adjuvant technique with CABG in patients with TCOs.
广泛弥漫性冠状动脉完全闭塞（CTO）是一个具有挑战性的外科手术问题。有人提出将广泛冠状动脉内膜切除术（CE）与冠状动脉旁路移植术（CABG）相结合作为一种血运重建技术。据称，先前的支架置入可能会影响手术结果。本研究旨在报告左前降支内膜切除术治疗CTO的结果，并确定先前支架置入对该结果的影响。
本项回顾性研究针对194例因左前降支（LAD）内膜切除术而接受治疗的CTO患者开展。为减少因患者选择不均衡而产生的偏倚，采用了倾向评分匹配分析。根据倾向评分，194例患者纳入分析。其中包括66例先前置入过支架的患者和128例未置入过支架的患者。对患者进行了中位（范围）74.0（6.0 - 149.0）个月的随访。主要研究结局为LAD移植血管通畅情况。其他结局参数包括术后并发症、住院时间、重症监护病房（ICU）住院时间及死亡率。
研究组间关于结局参数的比较显示，在移植血管通畅率（93.9%对89.1%；P = 0.27）、移植血管生存率（中位值[95%可信区间]：134.3个月[127.0 - 141.5]对135.2个月[128.4 - 142.0]；P = 0.35）、患者生存率（93.9%对91.4%）及患者生存时间（中位值[95%可信区间]：132.3个月[125.0 - 139.5]对138.0个月[132.0 - 144.1]；P = 0.75）方面均无显著差异。
本研究支持在CTO患者中将CE作为CABG的辅助技术使用。 患者与方法：本项回顾性研究针对194例因左前降支（LAD）内膜切除术而接受治疗的CTO患者开展。为减少因患者选择不均衡而产生的偏倚，采用了倾向评分匹配分析。根据倾向评分，194例患者纳入分析。其中包括66例先前置入过支架的患者和128例未置入过支架的患者。对患者进行了中位（范围）74.0（6.0 - 149.0）个月的随访。主要研究结局为LAD移植血管通畅情况。其他结局参数包括术后并发症、住院时间、重症监护病房（ICU）住院时间及死亡率。 结果：研究组间关于结局参数的比较显示，在移植血管通畅率（93.9%对89.1；p = 0.27）、移植血管生存率[中位值（95%可信区间）：134.3个月（127.0 - 141.5）对135.2个月（128.4 - 142.0）；p = 0.35]、患者生存率（93.9%对91.4%）及患者生存时间[中位值（95%可信区间）：（132.3个月（125.0 - 139.5）对138.0个月（132.0 - 144.1）；p = 0.75]方面均无显著差异。 结论：本研究支持在CTO患者中将CE作为CABG的辅助技术使用。
