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. 2018 Sep;33(7):1527-1535.
doi: 10.1007/s10103-018-2514-9. Epub 2018 May 7.

Ten-year follow-up after combined coronary artery bypass grafting and transmyocardial laser revascularization in patients with disseminated coronary atherosclerosis

Janusz Konstanty-Kalandyk  1 , Jacek Piątek  2 , Anna Kędziora  3 , Krzysztof Bartuś  2 , Rafał Drwila  4 , Tomasz Darocha  4 , Grzegorz Filip  2 , Bogusław Kapelak  2 , Bryan HyoChan Song  5 , Jerzy Sadowski  2
Affiliations

Ten-year follow-up after combined coronary artery bypass grafting and transmyocardial laser revascularization in patients with disseminated coronary atherosclerosis

Janusz Konstanty-Kalandyk et al. Lasers Med Sci. 2018 Sep.

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.

Keywords: Coronary artery bypass grating; Coronary artery disease; Disseminated coronary atherosclerosis; Transmyocardial laser revascularization.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimate. Freedom from all cause of death in combined vs. single therapy at any heart wall
Fig. 2
Fig. 2
Kaplan-Meier estimate. Freedom from cardiac death in combined vs. single therapy at any heart wall
Fig. 3
Fig. 3
Kaplan-Meier estimate. Freedom from all cause of death in combined vs. single therapy at anterior heart wall
Fig. 4
Fig. 4
Kaplan-Meier estimate. Freedom from cardiac death in combined vs. single therapy at anterior heart wall
See this image and copyright information in PMC

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