Abstract
Introduction Diffuse coronary artery disease (CAD) has a poor prognosis and many patients are ineligible for conventional coronary artery bypass grafting (CABG). This study evaluated the 12-month outcomes of coronary artery reconstruction and surgical patch angioplasty of the coronary artery for diffuse CAD. Methods A retrospective cohort study of patients who underwent CABG with surgical patch angioplasty of the coronary artery (reconstruction group) or standard CABG alone (standard group) at the Cardiovascular Surgery Department of the local Hospital between January 2014 and January 2016. Follow-up was censored at 12 months after surgery. Results Cardiopulmonary bypass and aortic cross-clamping durations were longer in the reconstruction group (n=32) than in the standard group (n=125) (P<0.05). There were no differences in graft blood flow and postoperative levels of cardiac markers between the two groups (P>0.05). In the reconstruction group, one patient died; a vein graft showed occlusion. In the standard group, two patients died; one left internal mammary artery graft and three vein grafts showed occlusion. There were no significant differences in mortality, major adverse cardiovascular and cerebrovascular events, and patency between the two groups (P>0.05).Conclusion Coronary artery reconstruction and surgical patch angioplasty of the coronary artery can be performed for diffuse CAD. Patient outcomes were not significantly different from those of patients who underwent standard CABG.
Highlights
Diffuse coronary artery disease (CAD) has a poor prognosis and many patients are ineligible for conventional coronary artery bypass grafting (CABG)
Coronary artery reconstruction and surgical patch angioplasty of the coronary artery can be performed for diffuse CAD
The surgical indications were: 1) stable angina pectoris: conservative treatment was ineffective; coronary artery angiography showed that the coronary artery trunk or the stenosis of proximal end of anterior descending branch/circumflex artery was >70%, patients with lesions in three branches of the coronary artery, especially patients with low left ventricular ejection fraction of cardiac function; 2) unstable angina: typical angina that affects daily life and work, and conservative treatment was ineffective; coronary artery angiography showed that the coronary artery trunk or the stenosis of proximal end of anterior descending branch/circumflex artery was >70%; 3) severe coronary stenosis: three major branches of the coronary artery had severe stenosis (>75%); and 4) failure of interventional treatment
Summary
Diffuse coronary artery disease (CAD) has a poor prognosis and many patients are ineligible for conventional coronary artery bypass grafting (CABG). This study evaluated the 12-month outcomes of coronary artery reconstruction and surgical patch angioplasty of the coronary artery for diffuse CAD. Diffuse coronary artery disease (CAD) is generally considered in the presence of a narrowing ≥70%) of a coronary artery ≥20 mm or in the presence of multiple stenoses encompassing the whole length of the coronary artery[1,2]. The prognosis of diffuse CAD after stenting or coronary artery bypass grafting (CABG) is unknown. One possible treatment for coronary artery stenosis is CABG, but many patients with diffuse CAD are ineligible to traditional.
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