.: ORİJİNAL ARAŞTIRMA
The Intramyocardial Left Anterior Descending Artery: Prevalence, Early and Mid-Term Surgical Outcomes After Coronary Artery Bypass Procedures: A Retrospective Single-Center Study
İntramiyokardiyal Sol Ön İnen Arter: Koroner Arter Baypas Prosedürlerinden Sonra Prevalans, Erken ve Orta Dönem Cerrahi Sonuçları: Retrospektif Tek Merkezli Çalışma
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(3):81-8
doi: 10.5336/cardiosci.2023-98006
Makale Dili: EN
Tam Metin
Ücretsiz Erişim
ABSTRACT
Objective: The aim of this study is to assess the prevalence of intramyocardial left anterior descending artery (IMLAD) and evaluate the early and mid-term outcomes in patients undergoing coronary artery bypass graft (CABG) procedures. Material and Methods: A retrospective analysis of 349 surgical reports of consecutive CABG procedures performed between January 2014 and October 2022 was conducted. Patients with IMLAD were matched with patients with epicardial left anterior descending artery (LAD) according to age, gender, and date of operation. A comparison between two groups was performed and follow-up data were obtained. Results: IMLAD was detected in 40 patients out of 349. The prevalence was 11.5%, and the median age was 56.5 years. There were 28 (70%) males. There were no statistically significant differences between the groups in terms of preoperative comorbidities, postoperative morbidities, reoperation rate for bleeding, mortality rates, and length of stay in the intensive care unit and the hospital. The cross-clamp and cardiopulmonary bypass times were comparable in both groups (p=0.350 and 0.765, respectively). The median follow-up time was 42 months (range 7-92 months) in the IMLAD group and 42.5 months (range 5-94 months) in the matched control group. Survival rates and freedom from reintervention rates were similar between the groups (p=0.368 and p=0.465, respectively). Conclusion: This study highlights the feasibility of performing surgeries involving IMLAD. Patients with IMLAD exhibited comparable early and mid-term clinical outcomes following CABG procedures compared to those with epicardial LAD.
Keywords: Coronary artery bypass; myocardial bridging; coronary vessels; prevalence
Objective: The aim of this study is to assess the prevalence of intramyocardial left anterior descending artery (IMLAD) and evaluate the early and mid-term outcomes in patients undergoing coronary artery bypass graft (CABG) procedures. Material and Methods: A retrospective analysis of 349 surgical reports of consecutive CABG procedures performed between January 2014 and October 2022 was conducted. Patients with IMLAD were matched with patients with epicardial left anterior descending artery (LAD) according to age, gender, and date of operation. A comparison between two groups was performed and follow-up data were obtained. Results: IMLAD was detected in 40 patients out of 349. The prevalence was 11.5%, and the median age was 56.5 years. There were 28 (70%) males. There were no statistically significant differences between the groups in terms of preoperative comorbidities, postoperative morbidities, reoperation rate for bleeding, mortality rates, and length of stay in the intensive care unit and the hospital. The cross-clamp and cardiopulmonary bypass times were comparable in both groups (p=0.350 and 0.765, respectively). The median follow-up time was 42 months (range 7-92 months) in the IMLAD group and 42.5 months (range 5-94 months) in the matched control group. Survival rates and freedom from reintervention rates were similar between the groups (p=0.368 and p=0.465, respectively). Conclusion: This study highlights the feasibility of performing surgeries involving IMLAD. Patients with IMLAD exhibited comparable early and mid-term clinical outcomes following CABG procedures compared to those with epicardial LAD.
Keywords: Coronary artery bypass; myocardial bridging; coronary vessels; prevalence
ÖZET
Amaç: Bu çalışmanın amacı, koroner arter baypas greft (KABG) uygulanan hastalarda intramiyokardiyal sol ön inen arter prevalansını ve erken ve orta dönem sonuçlarını değerlendirmektir. Gereç ve Yöntemler: Ocak 2014-Ekim 2022 arasında KABG operasyonu gerçekleştirilen 349 hasta retrospektif olarak analiz edildi. İntramiyokardiyal seyreden sol ön inen arteri olan hastalar, yaş, cinsiyet ve operasyon tarihine göre epikardiyal seyreden sol ön inen arteri olan hastalarla eşleştirildi. İki grup karşılaştırıldı ve takip verileri elde edildi. Bulgular: Üç yüz kırk dokuz hastanın 40'ında intramiyokardiyal sol ön inen arter tespit edildi. Prevalansı %11,5 idi, medyan yaş değeri 56,5 yıl idi. Yirmi sekizi (%70) erkek idi. İki grup arasında ameliyat öncesi komorbiditeler, ameliyat sonrası morbiditeler, kanama nedeniyle reoperasyon oranı, mortalite oranları ve yoğun bakım ve hastane yatış süreleri açısından istatistiksel olarak anlamlı fark bulunmadı. Her iki grupta kros klemp ve kardiyopulmoner baypas süreleri açısından istatistiksel olarak fark bulunamadı (sırasıyla p=0,350 ve 0,765). İntramiyokardiyal sol ön inen arter grubunda medyan takip süresi 42 ay (7-92 ay) iken, eşleştirilmiş kontrol grubunda 42,5 ay (5-94 ay) idi. Gruplar arasında sağkalım ve yeniden koroner anjiyografi oranları açısından istatistiksel olarak fark bulunmadı (sırasıyla p=0,368 ve p=0,465). Sonuç: Bu çalışma, intramiyokardiyal seyreden sol ön inen arter vakalarında, cerrahi uygulanabilirliğini vurgulamaktadır. İntramiyokardiyal seyreden sol ön inen arteri olan hastalar, epikardiyal seyreden sol ön inen arteri olan hastalara göre KABG sonrasında benzer erken ve orta dönem klinik sonuçlar göstermiştir.
Anahtar Kelimeler: Koroner arter baypas; miyokardiyal köprüleme; koroner damarlar; prevalans
Amaç: Bu çalışmanın amacı, koroner arter baypas greft (KABG) uygulanan hastalarda intramiyokardiyal sol ön inen arter prevalansını ve erken ve orta dönem sonuçlarını değerlendirmektir. Gereç ve Yöntemler: Ocak 2014-Ekim 2022 arasında KABG operasyonu gerçekleştirilen 349 hasta retrospektif olarak analiz edildi. İntramiyokardiyal seyreden sol ön inen arteri olan hastalar, yaş, cinsiyet ve operasyon tarihine göre epikardiyal seyreden sol ön inen arteri olan hastalarla eşleştirildi. İki grup karşılaştırıldı ve takip verileri elde edildi. Bulgular: Üç yüz kırk dokuz hastanın 40'ında intramiyokardiyal sol ön inen arter tespit edildi. Prevalansı %11,5 idi, medyan yaş değeri 56,5 yıl idi. Yirmi sekizi (%70) erkek idi. İki grup arasında ameliyat öncesi komorbiditeler, ameliyat sonrası morbiditeler, kanama nedeniyle reoperasyon oranı, mortalite oranları ve yoğun bakım ve hastane yatış süreleri açısından istatistiksel olarak anlamlı fark bulunmadı. Her iki grupta kros klemp ve kardiyopulmoner baypas süreleri açısından istatistiksel olarak fark bulunamadı (sırasıyla p=0,350 ve 0,765). İntramiyokardiyal sol ön inen arter grubunda medyan takip süresi 42 ay (7-92 ay) iken, eşleştirilmiş kontrol grubunda 42,5 ay (5-94 ay) idi. Gruplar arasında sağkalım ve yeniden koroner anjiyografi oranları açısından istatistiksel olarak fark bulunmadı (sırasıyla p=0,368 ve p=0,465). Sonuç: Bu çalışma, intramiyokardiyal seyreden sol ön inen arter vakalarında, cerrahi uygulanabilirliğini vurgulamaktadır. İntramiyokardiyal seyreden sol ön inen arteri olan hastalar, epikardiyal seyreden sol ön inen arteri olan hastalara göre KABG sonrasında benzer erken ve orta dönem klinik sonuçlar göstermiştir.
Anahtar Kelimeler: Koroner arter baypas; miyokardiyal köprüleme; koroner damarlar; prevalans
REFERANSLAR:
- Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105(20):2449-54. [Crossref] [PubMed]
- Vanker EA, Ajayi NO, Lazarus L, Satyapal KS. The intramyocardial left anterior descending artery: prevalence and surgical considerations in coronary artery bypass grafting. S Afr J Surg. 2014;52(1):18-21. [PubMed]
- Çullu N, Yeniçeri İÖ, Özdemir MY, Altun İ, Doğan E. Evaluation of the morphological and clinical features of left anterior descending myocardial bridging with multi-detector computed tomography. Kardiochir Torakochirurgia Pol. 2021;18(2):87-91. [Crossref] [PubMed] [PMC]
- Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S. Left anterior descending artery myocardial bridging: a clinical approach. J Am Coll Cardiol. 2016;68(25):2887-99. [Crossref] [PubMed]
- Aydin U, Kocogullari CU. A method for locating embedded left anterior descending coronary arteries. Ann Thorac Surg. 2013;95(1):360-1. [Crossref] [PubMed]
- Kızıltan HT, Salihi S, İdem A, Pekedis A. Embedded left anterior descending artery during coronary bypass operations: a 15-year experience. Heart Lung Circ. 2015;24(11):1118-25. [Crossref] [PubMed]
- Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49(5):587-93. [Crossref] [PubMed]
- Mookadam F, Green J, Holmes D, Moustafa SE, Rihal C. Clinical relevance of myocardial bridging severity: single center experience. Eur J Clin Invest. 2009;39(2):110-5. [Crossref] [PubMed]
- Bárczi G, Becker D, Sydó N, Ruzsa Z, Vágó H, Oláh A, et al. Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge. J Cardiovasc Dev Dis. 2022;9(5):129. [Crossref] [PubMed] [PMC]
- Matta A, Canitrot R, Nader V, Blanco S, Campelo-Parada F, Bouisset F, et al. Left anterior descending myocardial bridge: Angiographic prevalence and its association to atherosclerosis. Indian Heart J. 2021;73(4):429-33. [Crossref] [PubMed] [PMC]
- Sajjadieh A, Hekmatnia A, Keivani M, Asoodeh A, Pourmoghaddas M, Sanei H. Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography. ARYA Atheroscler. 2013;9(2):157-63. [PubMed] [PMC]
- Arslan C, Kayhan B, Cantürk E, Bozkurt AK. Angiographic characteristics of major intramural coronary arteries and their effect on coronary bypass surgery. Acta Cardiol. 2009;64(5):627-31. [Crossref] [PubMed]
- Apostolakis E, Koletsis E, Leivaditis V, Lozos V, Dougenis D. A safe technique of exposing of a "hidden" left anterior descending artery. J Card Surg. 2007;22(6):505-6; discussion 507. [Crossref] [PubMed]
- Hiratzka LF, McPherson DD, Brandt B 3rd, Lamberth WC Jr, Marcus ML, Kerber RE. Intraoperative high-frequency epicardial echocardiography in coronary revascularization: locating deeply embedded coronary arteries. Ann Thorac Surg. 1986;42(6 Suppl):S9-11. [Crossref] [PubMed]
- Mandegar MH, Roshanali F, Saidi B. New technique for localizing intramyocardial left anterior descending artery. Ann Thorac Surg. 2010;89(4):1342; author reply 1342-3. [Crossref] [PubMed]
- Oda K, Hirose K, Fukutomi T, Yamashiro T, Ogoshi S. Intraoperative detection of embedded coronary arteries in MIDCAB using a color Doppler microprobe. Ann Thorac Surg. 1999;68(1):263-4. [Crossref] [PubMed]
- Oz MC, Cooper MM, Hickey TJ, Rose EA. Exposure of the intramyocardial left anterior descending artery. Ann Thorac Surg. 1994;58(4):1194-5. [Crossref] [PubMed]
- De Salvatore S, Segreto A, Chiusaroli A, Congiu S, Bizzarri F. Surgical Management of Intramyocardial Left Anterior Descending Artery. J Card Surg. 2015;30(11):805-7. [Crossref] [PubMed]
- Parachuri RV, Chattuparambil B, Hasabettu PK, Punnen J, Dhaded S, Sadagopan DR, et al. Marsupialization of intramyocardial left anterior descending artery: a novel approach for easy access during revascularization. Ann Thorac Surg. 2005;80(6):2390-2. [Crossref] [PubMed]
- Calafiore AM, Giammarco GD, Teodori G, Bosco G, D'Annunzio E, Barsotti A, et al. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg. 1996;61(6):1658-63; discussion 1664-5. [Crossref] [PubMed]
- Brown JM, Poston RS, Gammie JS, Cardarelli MG, Schwartz K, Sikora JA, et al. Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes. Ann Thorac Surg. 2006;81(2):555-61; discussion 561. [Crossref] [PubMed]
- Alegria JR, Herrmann J, Holmes DR Jr, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J. 2005;26(12):1159-68. [Crossref] [PubMed]
- Ishii T, Asuwa N, Masuda S, Ishikawa Y, Kiguchi H, Shimada K. Atherosclerosis suppression in the left anterior descending coronary artery by the presence of a myocardial bridge: an ultrastructural study. Mod Pathol. 1991;4(4):424-31. [PubMed]
- Masuda T, Ishikawa Y, Akasaka Y, Itoh K, Kiguchi H, Ishii T. The effect of myocardial bridging of the coronary artery on vasoactive agents and atherosclerosis localization. J Pathol. 2001;193(3):408-14. [Crossref] [PubMed]
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