Introduction: Despite the advances of interventional catheterization, surgery remains the treatment of choice for some coronary
lesions. Objective: To report the indications and results of
surgical revascularization of the myocardium at the Abidjan Heart Institute. Patient
and Methods: This is a retrospective study of patients with coronary
insufficiency who underwent surgical myocardial revascularization between March
2014 and May 2020 in the Cardiovascular Surgery Department of the Abidjan Heart
Institute. There were 17 patients, 11 of whom were men (64.7%) and 6 women
(35.3%), The mean age of the patients was 57.5 years ± 8.8. All patients were
symptomatic with disabling angina in class
III of the Canadian Cardiac Society (CCS). This sym- ptomatology had been
evolving on average for 5 years and 6 patients had a history of acute coronary syndrome, 2 of whom had undergone prior
angioplasty. Coronary angiography revealed mono-truncated (17.6%),
bi-truncated (23.5%) and tri-truncated (58.8%) lesions. Results: The
patients were operated under cardiopulmonary bypass(CPB)15cases
(88.2%) and off pump in 2 cases (11.8%). They underwent a single bypass in 23.5% of cases, a
double bypass in 47.1% of cases and a triple bypass in 29.4% of cases. We
observed 3 cases of complications (17.6%), namely transient acute renal
failure, mediastinitis and postoperative bleeding. The operative and hospital
mortality was nil. After a mean follow-up of 3 ± 1.8 years, all patients were
asymptomatic with a negative stress test at last check-up. Conclusion: Our experience has allowed us to demonstrate the safe performance of surgical
myocardial revascularization in our patients with satisfactory and encouraging
results.
References
[1]
Bertrand, M., Simoons, M.L., Fox, K.A.A., Wallentin, L.C., Hamm, C.W., McFadden, E., et al. (2000) Management of Acute Coronary Syndromes: Acute Coronary Syndromes without Persistent ST Segment Elevation. Recommendations of the Task Force of the European Society of Cardiology. European Heart Journal, 21, 1406- 1432. https://doi.org/10.1053/euhj.2000.2301
[2]
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 310 Diseases and Injuries, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1545-1602. https://doi.org/10.1016/S0140-6736(16)31678-6
[3]
Ticolat, P., Bertrand, E., Baeabe P, Bouramoue, C., Burdin, J., Diouf, S., et al. (1991) Epidemiological Aspects of Coronary Heart Disease in Black Africans: 103 Cases. Results of the Prospective Multicenter Survey CORONAFRIC. Cardiologie Tropicale, 17, 7-20.
[4]
Aw, F., Ndiaye, M.B., Ndiaye, P.N., Bakari, M., Bodian, M., Mingou, J., et al. (2019) Clinical and Angiographic Difference between Ischemic and Dilated Cardiomyopathy in Sub-Saharan Africa Example of Senegal. Jaccr Africa, 3, 453-459.
[5]
Touze, J.E. (2007) Cardiovascular Diseases and the Epidemiological Transition of the Tropical World. Medecine Tropicale, 67, 541-542.
[6]
N’guetta, R., Yao, H., Ekou, A., N’cho-Mottoh, M.P., Angoran, I., Tano, M., et al. (2016) Prevalence and Characteristics of Acute Coronary Syndromes in a Sub-Sa- haran African Population. Annals of Cardioliology and Angeiology, 65, 59-63. https://doi.org/10.1016/j.ancard.2016.01.001
[7]
Angelini, G.D., Culliford, L., Smith, D.K., Hamilton, M.C.K., Murphy, G.J., Ascione, R., et al. (2009) Effects of On- and Off-Pump Coronary Artery Surgery on Graft Patency, Survival and Health-Related Quality of Life: Long-Term Follow-up of 2 Randomized Controlled Trials. Journal of Thoracic and Cardiovascular Surgery, 137, 295-303. https://doi.org/10.1016/j.jtcvs.2008.09.046
[8]
French Society of Thoracic and Cardiovascular Surgery (2014) DATABASES Eleventh Report.
[9]
Windecker, S., Kolh, P., Alfonso, F., Collet, J.P., Cremer, J., Falk V., et al. (2014) ESC/EACTS Guidelines on Myocardial Revascularization. European Heart Journal, 35, 2541-2619. https://doi.org/10.1093/eurheartj/ehu278
[10]
Ait Houssa, M., et al. (2013) Outcome of Coronary Artery Bypass Surgery for Left Ventricular Dysfunction: Comparison of Beating Heart and Bypass Surgery. Annals of Cardiology, 62, 241-247
[11]
Barandon, L., et al. (2008) Early Outcomes of Beating Heart Coronary Artery Bypass Surgery in Very High-Risk Operative Patients. Cardiovascular Thoracic Surgery, 12, 95-105.
[12]
Younes, M., Khadija, B., Mahdi, A., Nourredine, A., Brahim, A., et al. (2014) Coronary Surgery under Extracorporeal Circulation in the Diabetic Patient Military Hospital. Pan African Medical Journal, 17, Article No. 199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229003/pdf/PAMJ-17-199.pdf
[13]
Bastien, O., Piriou, V., Aouifi, A., Flamens, C., Evans, R. and Lehot, J.J. (2000) Relative Importance of Flow versus Pressure in Splanchnic Perfusion during Cardiopulmonary Bypass in Rabbits. Anesthesiology, 92, 457-464. https://doi.org/10.1097/00000542-200002000-00028
[14]
Monassier, F., Mattei, C., Gavra, G., Dallemand, R., Lallemant, P., Olteane, C., et al. (2005) Beating Heart Coronary Bypass Surgery: About 1080 Patients. Annales de Cardiologie et d’Angéiologie, 54, 299-304. https://doi.org/10.1016/j.ancard.2005.09.006
[15]
Straka, Z., Widimsky, P., Jirasek, K., Stros, P., Votava, J., Vanek T., et al. (2004) Off-Pump versus On-Pump Coronary Revascularization: Meta-Analysis of Mid- and Long-Term Outcomes. Annals of Thoracic Surgery, 77, 789-793. https://doi.org/10.1016/j.athoracsur.2003.08.039
[16]
Girard, C., Mauriat, P., Goudeau, J.J., D’Athis, P., Bompard, D., Dalmas, J.P., Fellahi, J.L., et al. (2004) Anesthesia in Adult Cardiac Surgery in France in 2001: Results of the ARTECC Club’s National Three-Day Survey. Annales Fran?aise d’Anesthesie Reanimation, 23, 862-872. https://doi.org/10.1016/j.annfar.2004.07.011
[17]
Bridgewater, B. and Gummert, J. (2010) Fourth EACTS Adult Cardiac Surgical Database Report towards Global Benchmarking. The European Association for Cardio-Thoracic Surgery, Windsor Castle.
[18]
Cameron, A., Davis, K.B., Green, G. and Schaff, H.V. (1996) CABG with Internal-Thoracic-Artery Grafts—Effects on Survival over a 15-Year Period. New England Journal of Medicine, 334, 216-220. https://doi.org/10.1056/NEJM199601253340402
[19]
Cheng, A. and Slaughter, M.S. (2013) How I Choose Conduits and Configure Grafts for My Patients-Rationales and Practices. Annals of Cardiothoracic Surgery, 2, 527- 532.
[20]
Lytle, B.W., Blackstone, E.H., Sabik, J.F., Houghtaling, P., Loop, F.D., Cosgrove, D.M., et al. (2004) The Effect of Bilateral Internal Thoracic Artery Grafting on Survival during 20 Postoperative Years. Annals of Thoracic Surgery, 78, 2005-2014. https://doi.org/10.1016/j.athoracsur.2004.05.070
[21]
Taggart, D.P., Douglas, G.A., Alastair, M.G., Lees, B., Nugara, F., Yu, L.-M, et al. (2010) Randomised Trial to Compare Bilateral versus Single Internal Mammary Coronary Artery Bypass Grafting: 1-Year Results of the Arterial Revascularisation Trial (ART). European Heart Journal, 31, 2470-2481. https://doi.org/10.1093/eurheartj/ehq318
[22]
Abu-Omar, Y. and Taggart, D.P. (2002) Off-Pump Coronary Artery Bypass Grafting. Lancet, 360, 327-329. https://doi.org/10.1016/S0140-6736(02)09557-0
[23]
Durrleman, N. and Cartier, R. (2006) Beating Heart Coronary Revascularization: Theoretical and Practical Aspects. EMC (Elsevier Masson SAS, Paris), Techniques Chirurgicales-Thorax, 42-700-L.
[24]
Sellier, P., Chatellier, G., Dubois, C., d’Agrosa-Boiteux, M.C., Davard, H., Goepfert, P.C., et al. (2001) Prognosis and Risk Assessment in the Operated Coronary Patient (PERISCOP). Methodology and Study Population Characteristics. Archives des Maladies du Coeur et des Vaisseaux, 94, 9-15.
[25]
Athanasiou, T., Crossman, M.C., Asimakopoulos, G., Cherian, A., Weerasinghe, A., Glenville, B, et al. (2004) Should the Internal Thoracicartery Be Skeletonised? Annals of Thoracic Surgery, 77, 2238-2246. https://doi.org/10.1016/j.athoracsur.2003.10.041
[26]
Calafiore, A.M., Vitolla, G., Iaco, A.L., Fino, C., Di Giammarco, G., Marchesani, F., et al. (1999) Bilateral Internal Mammary Artery Grafting: Midterm Results of Pedicled vs. Skeletonised Conduits. Annals of Thoracic Surgery, 67, 1637-1642. https://doi.org/10.1016/S0003-4975(99)00282-9
[27]
Kim, K.B., Lim, C., Lee, C., Chae, I.-H., Oh, B.-H., Lee, M.-M., et al. (2001) Off Pump Coronary Bypass May Decrease the Patency of Saphenous Vein Graft. Annals of Thoracic Surgery, 72, 1033-1037. https://doi.org/10.1016/S0003-4975(01)02946-0
[28]
Ahmed, H.B. (2012) Mono-Bypass versus Bilateral Internal Mammary Bypass: Immediate and Medium-Term Results. La tunisie Medicale, 90, 720-724.
