Abstract
Coronary artery disease involving heavily calcified lesions has been associated with worse short- and long-term outcomes including increased mortality. This paper aims to evaluate long-term survival benefit when CABG + transmyocardial laser revascularization (TMLR) are performed on the hearts of patients with disseminated coronary atherosclerosis (DCA). This novel retrospective study was conducted between 1997 and 2002 and followed 86 patients with ischemic heart disease and severe DCA who underwent TMLR using a Holmium:YAG laser and/or CABG. There were 46 patients who had CABG plus TMLR on at least one heart wall (“combined therapy group”) and 40 patients who had CABG or TMLR separately on at least one heart wall (“single therapy group”). For the whole group, actuarial survival at 10 years was 78.3% in the combined group compared to 72.5% in the single therapy group (p = 0.535). Ten-year survival in the combined vs. single therapy group for the anterior heart walls was 100 vs. 72.2% (p = 0.027). For the lateral and posterior heart walls were 73.7 vs. 73.3% (p = 0.97) and 84.2 vs. 72% (p = 0.27), respectively. Kaplan-Meier survival analysis showed benefit only for the anterior heart wall (F Cox test, p = 0.103). Single therapy procedures on all heart walls (odds ratio 1.736, p = 0.264) or on the anterior heart wall only (odds ratio 3.286, p = 0.279) were found to be predictors of 10-year late mortality. Combined therapy (TMLR + CABG) provides benefit for perioperative mortality and long-term survival only when provided on the anterior heart wall. For patients with disseminated coronary atherosclerosis, cardiac mortality was found to be increased when followed up 6 years later, regardless of the therapy applied.
Highlights
Coronary artery bypass grafting and percutaneous coronary interventions are effective methods of myocardial revascularization for patients with coronary artery disease
Similar outcomes have been observed in coronary bypass grafting operations, as patients with calcified coronaries had increased rates of mortality and death from myocardial infarction (MI) at 5-year follow-up when compared to patients without calcified coronary arteries [6]
The combination of transmyocardial laser revascularization (TMLR) and CABG on the same wall of the heart was beneficial for patients with diffuse atherosclerosis, since the advanced atherosclerotic process prohibited adequate blood supply to the area even when the graft was working properly
Summary
Coronary artery bypass grafting and percutaneous coronary interventions are effective methods of myocardial revascularization for patients with coronary artery disease. The population of patients eligible for revascularization has changed in recent years, in regard to significantly increased patient age, number of associated diseases, and number of patients with diabetes. These factors have been reported to exacerbate the development of atherosclerosis [1]. Severe lesion calcification has been identified as an independent predictor of increased all-cause mortality (HR 1.39) by multivariate Cox regression analysis [6]
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