Incidence of Total Occlusion of Right Coronary Artery and Its Treatment Strategy During Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAIChen , LIJing-xing , WANGChuan , ZHANGFan , GAOMing-xin ,  GUCheng-xiong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding author：

GUCheng-xiong, Email: anzhengu@sina.com

Keywords：

Total occlusion of right coronary artery; Off-pump coronary artery bypass grafting; Coronary artery disease

DOI：

10.7507/1007-4848.20140213

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the incidence of total occlusion of right coronary artery (RCA)and its treatment strategy during off-pump coronary artery bypass grafting (OPCAB). Methods A total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January 1, 2005 to December 31, 2012. There were 889 male (77.1%)and 264 female (22.9%)patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. Results Among 6 206 OPCAB patients, 1 153 patients (18.6%)had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients (1.1%)died postoperatively. Thirty-four patients (2.9%)had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients (97.4%)were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. Conclusion The incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.

Citation： BAIChen, LIJing-xing, WANGChuan, ZHANGFan, GAOMing-xin, GUCheng-xiong. Incidence of Total Occlusion of Right Coronary Artery and Its Treatment Strategy During Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 740-743. doi: 10.7507/1007-4848.20140213 Copy

1.	Saito S, Tanaka S, Hiroe Y, et al. Angioplasty for chronic total occlusion by using tapered-tip guidewires. Catheter Cardiovasc Interv, 2003, 59(3):305-311.
2.	Nakajima H, Kobayashi J, Toda K, et al. A 10-year angiographic follow-up of competitive flow in sequential and composite arterial grafts. Eur J Cardiothorac Surg, 2011, 40(2):399-404.
3.	Jeong DS, Lee HY, Min HK, et al. Graft selection for the right coronary artery territory in Off-Pump coronary artery bypass. Thorac Cardiovasc Surg, 2012, 60(7):432-437.
4.	Bouchot O, Aubin MC, Carrier M, et al. Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicar-dial coronary arteries. J Thorac Cardiovasc Surg, 2006, 132(5):1144-1149.
5.	谷天祥, 喻磊, 姜春力, 等.左主干完全闭塞的外科治疗.中国胸心血管外科临床杂志, 2008, 15(3):225-227.
6.	Aziz S, Stables RH, Grayson AD, et al. Percutaneous coronary inter-vention for chronic total occlusions:improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovasc Interv, 2007, 70(1):15-20.
7.	Şahiner L, Canpolat U, Aytemir K, et al. Diagnostic accuracy of 16-versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts:a comparative study. Interact Cardiovaus Thorac Surg, 2012, 15(5):847-853.
8.	Cheng XG, Yang JF, Li LK. Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft. J Geriatr Cardiol, 2012, 9(3)247-251.
9.	Hayakawa M, Asai T, Shiraishi S. Target vessel detection by epicar-dial ultrasound in off-pump coronary bypass surgery. Innovations(Phila), 2013, 8(4):249-252.
10.	Omelchenko AY, Zhuang Z, Schreiber C, et al. Surgical off-pump closure of perimembranous ventricular septal defects. Asian Cardiovasc Thorac Ann, 2014, 22(1):31-35.
11.	Khan NE, De Souza A, Mister R, et al. A Randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery. N Engl J Med, 2004, 350(1):21-28.
12.	Aziz S, Stables RH, Grayson AD, et al. Percutaneous coronary intervention for chronic total occlusions:improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovasc Interv, 2007, 70(1):15-20.
13.	Mebazaa A, Pitsis AA, Rudiger A, et al. Clinical review:Practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit Care, 2010, 14(2):201.
14.	Ali E, Saso S, Ashrafian H, et al. Does a skeletonized or pedicled right gastro-epiploic artery improve patency when used as a conduit in coronaryartery bypass graft surgery? Interact Cardiovasc Thorac Surg, 2010, 10(2):293-298.
15.	Hwang HY, Kim JS, Oh SJ, et al. A randomized comparison of the saphenous vein versus right internal thoracic artery as a Y-composite graft(SAVE RITA)trial:early results. J Thorac Cardiovasc Surg, 2012, 144(5):1027-1033.
16.	Villareal RP, Lee VV, Elayda MA, et al. Coronary artery bypass surgery versus coronary stenting risk-adjusted survival rates in 5 619 Patients. Tex Heart Inst J, 2002, 29(1):3-9.
17.	Abboud B, Daher R, Boujaoude J. Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol, 2008, 14(35):5361-5370.
18.	蒙炜, 石应康, 程述森, 等.冠状动脉旁路移植术166例临床分析.中国胸心血管外科临床杂志, 2007, 14(4):312-313.
19.	陈鑫, 徐明, 汪黎明, 等.非体外循环下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变.中华外科杂志, 2006, 44(14):940-942.
20.	Cohen MV, Downey JM, Sonnenblick EH, et al. The effects of nitroglycerin on coronary collaterals and myocardial contractility. J Clin Invest, 1973, 52(11):2836-2847.
21.	Wu C, Camacho FT, Culliford AT, et al. A comparison of long-term mortality for off-pump and on-pump coronary artery bypass graft surgery. Circ Cardiovasc Qual Outcomes, 2012, 5(1):76-84.
22.	Apaydin AZ, Oguz E, Posacioglu H, et al. Reoperative off-pump right subclavian artery to right coronary artery bypass grafting without full sternotomy. J Card Surg, 2011, 26(2):148-150.
23.	Mujanović E, Bergsland J, Kabil E. Off-pump coronary bypass grafting in patient with left main occlusion and 75% stenosis of right coronary artery. Med Arh, 2007, 61(2 Suppl 1):51-53.
24.	Vural KM, Iscan ZH, Kunt A, et al. Off-pump coronary artery bypass grafting:Long-term angiographic results. J Card Surg, 2005, 20(2):153-159.
25.	于洋, 顾承雄, 李海涛.非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化手术的疗效分析.中国胸心血管外科临床杂志, 2011, 18(5):394-398.

1. Saito S, Tanaka S, Hiroe Y, et al. Angioplasty for chronic total occlusion by using tapered-tip guidewires. Catheter Cardiovasc Interv, 2003, 59(3):305-311.
2. Nakajima H, Kobayashi J, Toda K, et al. A 10-year angiographic follow-up of competitive flow in sequential and composite arterial grafts. Eur J Cardiothorac Surg, 2011, 40(2):399-404.
3. Jeong DS, Lee HY, Min HK, et al. Graft selection for the right coronary artery territory in Off-Pump coronary artery bypass. Thorac Cardiovasc Surg, 2012, 60(7):432-437.
4. Bouchot O, Aubin MC, Carrier M, et al. Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicar-dial coronary arteries. J Thorac Cardiovasc Surg, 2006, 132(5):1144-1149.
5. 谷天祥, 喻磊, 姜春力, 等.左主干完全闭塞的外科治疗.中国胸心血管外科临床杂志, 2008, 15(3):225-227.
6. Aziz S, Stables RH, Grayson AD, et al. Percutaneous coronary inter-vention for chronic total occlusions:improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovasc Interv, 2007, 70(1):15-20.
7. Şahiner L, Canpolat U, Aytemir K, et al. Diagnostic accuracy of 16-versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts:a comparative study. Interact Cardiovaus Thorac Surg, 2012, 15(5):847-853.
8. Cheng XG, Yang JF, Li LK. Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft. J Geriatr Cardiol, 2012, 9(3)247-251.
9. Hayakawa M, Asai T, Shiraishi S. Target vessel detection by epicar-dial ultrasound in off-pump coronary bypass surgery. Innovations(Phila), 2013, 8(4):249-252.
10. Omelchenko AY, Zhuang Z, Schreiber C, et al. Surgical off-pump closure of perimembranous ventricular septal defects. Asian Cardiovasc Thorac Ann, 2014, 22(1):31-35.
11. Khan NE, De Souza A, Mister R, et al. A Randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery. N Engl J Med, 2004, 350(1):21-28.
12. Aziz S, Stables RH, Grayson AD, et al. Percutaneous coronary intervention for chronic total occlusions:improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovasc Interv, 2007, 70(1):15-20.
13. Mebazaa A, Pitsis AA, Rudiger A, et al. Clinical review:Practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit Care, 2010, 14(2):201.
14. Ali E, Saso S, Ashrafian H, et al. Does a skeletonized or pedicled right gastro-epiploic artery improve patency when used as a conduit in coronaryartery bypass graft surgery? Interact Cardiovasc Thorac Surg, 2010, 10(2):293-298.
15. Hwang HY, Kim JS, Oh SJ, et al. A randomized comparison of the saphenous vein versus right internal thoracic artery as a Y-composite graft(SAVE RITA)trial:early results. J Thorac Cardiovasc Surg, 2012, 144(5):1027-1033.
16. Villareal RP, Lee VV, Elayda MA, et al. Coronary artery bypass surgery versus coronary stenting risk-adjusted survival rates in 5 619 Patients. Tex Heart Inst J, 2002, 29(1):3-9.
17. Abboud B, Daher R, Boujaoude J. Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol, 2008, 14(35):5361-5370.
18. 蒙炜, 石应康, 程述森, 等.冠状动脉旁路移植术166例临床分析.中国胸心血管外科临床杂志, 2007, 14(4):312-313.
19. 陈鑫, 徐明, 汪黎明, 等.非体外循环下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变.中华外科杂志, 2006, 44(14):940-942.
20. Cohen MV, Downey JM, Sonnenblick EH, et al. The effects of nitroglycerin on coronary collaterals and myocardial contractility. J Clin Invest, 1973, 52(11):2836-2847.
21. Wu C, Camacho FT, Culliford AT, et al. A comparison of long-term mortality for off-pump and on-pump coronary artery bypass graft surgery. Circ Cardiovasc Qual Outcomes, 2012, 5(1):76-84.
22. Apaydin AZ, Oguz E, Posacioglu H, et al. Reoperative off-pump right subclavian artery to right coronary artery bypass grafting without full sternotomy. J Card Surg, 2011, 26(2):148-150.
23. Mujanović E, Bergsland J, Kabil E. Off-pump coronary bypass grafting in patient with left main occlusion and 75% stenosis of right coronary artery. Med Arh, 2007, 61(2 Suppl 1):51-53.
24. Vural KM, Iscan ZH, Kunt A, et al. Off-pump coronary artery bypass grafting:Long-term angiographic results. J Card Surg, 2005, 20(2):153-159.
25. 于洋, 顾承雄, 李海涛.非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化手术的疗效分析.中国胸心血管外科临床杂志, 2011, 18(5):394-398.

Previous Article
Reason, Prevention, and Treatment of Gastrointestinal Unplanned Reoperation
Next Article
Reactive Lymphoid Hyperplasia of Liver: A Case Report and Review of The Literatures

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Incidence of Total Occlusion of Right Coronary Artery and Its Treatment Strategy During Off-pump Coronary Artery Bypass Grafting

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content