Shehada Sharaf-Eldin, Mourad Fanar, Haddad Ali, Darwish Belal, Ryadi Noura, Balaj Ilir, Jakob Heinz, Ruhparwar Arjang
West German Heart and Vascular Centre, Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
J Clin Med. 2022 Nov 28;11(23):7026. doi: 10.3390/jcm11237026.
Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% ( = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally ( = 111, 28.2%) or sub-totally ( = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.
背景 - 冠状动脉内膜切除术（CEA）是治疗严重弥漫性冠状动脉疾病的一种选择；然而，由于其复杂性以及报道的有争议的结果，许多外科医生避免进行该手术。因此，我们旨在回顾冠状动脉旁路移植术（CABG）中接受CEA治疗的患者的结果。
方法 - 这是一项回顾性观察性研究，评估2003年3月至2018年2月期间在CABG手术中接受CEA治疗的患者的结果。通过积极的个人和/或电话访谈进行随访，以评估长期临床结果。研究终点包括术后早期心肌梗死或心脏死亡率、长期生存率以及无主要不良心脏和脑血管事件（MACCE）。
结果 - 本研究共纳入326例患者进行评估。患者的平均年龄为67岁；88%为男性，大多数表现为三支血管病变，平均SYNTAX评分为33.1±12。约5.5%（n = 18）的患者曾接受过CABG手术。每位患者平均进行4.3±1.1次移植手术，共进行了394次CEA。CEA的指征为冠状动脉完全闭塞（n = 111，28.2%）或次全闭塞（n = 283，71.8%）。早期结果包括8例（2.4%）围手术期心肌梗死、8例（2.4%）中风和13例（4.0%）住院死亡率。长期临床随访报告，在十年随访时，27.6%的患者死亡，41.4%的患者发生MACCE。
结论 - 严重弥漫性CAD患者是外科血运重建的困难候选者。CEA提供了一种选择，即使在慢性闭塞的情况下，当心肌仍有活力时，也能实现完全血运重建。这里介绍的闭合牵引CEA技术是我们的首选方法；它取得了令人满意的短期和长期结果。
