Document Detail


Is chronic total coronary occlusion a risk factor for long-term outcome after minimally invasive bypass grafting of the left anterior descending artery?
MedLine Citation:
PMID:  20417767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic total occlusion (CTO) of coronary vessels is still a challenge for percutaneous coronary intervention and recent data show unfavorable long-term results compared with medical therapy. It is unclear whether CTO is also a negative predictor for long-term outcome in minimally invasive bypass grafting. METHODS: From 1996 to 2007 minimally invasive surgical revascularization of the left internal mammary artery to the left anterior descending artery (LAD) was performed in 1,800 patients. Demographic data, risk factors, perioperative outcome, and annual follow-up were obtained from all patients. Estimated survival and freedom from major adverse cardiac and cerebrovascular events or recurrence of angina with log-rank tests and Cox regression analysis for identification of independent risk factors were calculated for patients with (420 patients) and without (1,380 patients) CTO of the LAD. RESULTS: Revascularization of the LAD could be completed in all but one patient (99.8% success rate with CTO). At 5 years estimated overall survival was 90.5% (95% confidence interval [CI] 85.8 to 95.5) with CTO and 90.4% (95% CI 85.8 to 95.1) without CTO (p = 0.91). Freedom from major adverse cardiac and cerebrovascular events and angina with or without CTO at 5 years was 83.2% (95% CI 77.6 to 88.8) and 85.5% (95% CI 82.6 to 88.1), respectively (p = 0.64). Chronic occlusion of the target vessel and other preoperative factors were not identified as risk factors for major adverse cardiac and cerebrovascular events during follow-up. CONCLUSIONS: As opposed to percutaneous coronary intervention, minimally invasive bypass grafting of a totally occluded LAD is almost always possible and chronic occlusion is not a negative predictor for short and long-term outcome. Minimally invasive bypass grafting of the LAD should be considered the treatment of choice for chronically occluded left anterior descending arteries.
Authors:
David M Holzhey; Stephan Jacobs; Thomas Walther; Friedrich W Mohr; Volkmar Falk
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1496-501     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. dholzhey@web.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Cause of Death*
Chronic Disease
Cohort Studies
Coronary Angiography
Coronary Artery Bypass / methods*,  mortality
Coronary Occlusion / mortality*,  radiography,  surgery*
Coronary Vessels / surgery
Female
Follow-Up Studies
Hospital Mortality / trends
Humans
Kaplan-Meiers Estimate
Male
Mammary Arteries / transplantation*
Middle Aged
Postoperative Complications / mortality
Probability
Retrospective Studies
Risk Assessment
Safety Management
Severity of Illness Index
Statistics, Nonparametric
Surgical Procedures, Minimally Invasive / methods,  mortality
Survival Analysis
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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