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JACC April 5, 2016

Volume 67, Issue 13

FIT Clinical Decision Making

A RIGHT CORONARY ARTERY BYPASS DILEMMA: COMBINED CORONARY ENDARTERECTOMY WITH
CORONARY BYPASS SAVED THE DAY
Poster Contributions
Poster Area, South Hall A1
Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m.
Session Title: FIT Clinical Decision Making: Acute Coronary Syndrome, Stable Ischemic Heart Disease, Interventional Cardiology, Vascular
Medicine
Abstract Category: Acute Coronary Syndromes
Presentation Number: 1185-281
Authors: Muhanad Al-Zubaidi, K. H. Lim, Wright State University, Dayton, OH, USA, Premier Health- Good Samaritan Hospital, Dayton,
OH, USA

Background: The increasing incidence of diffuse coronary artery disease in the current era challenges cardiac surgeons in accomplishing
their goal of complete revascularization. Controversy still exists for CE indications, technique, and results. The purpose of this presentation
is to highlight the feasibility and comparable success of CE to the RCA.

Abstract: An 82 year-old female underwent coronary angiogram for ongoing angina, which showed severe disease of the left main and
LAD and total RCA occlusion. She was referred for coronary bypass surgery and had LIMA bypassed to LAD and saphenous vein graft
(SVG) to the first optimal marginal branch and diagonal branched of the LAD. Intra-operatively, the RCA was calcified and there was no soft
area to construct the distal anastomosis. We were forced to perform endarterectomy of the RCA with its posterior descending branch and
the posterolateral branch of the RCA. SVG was bypassed to RCA. Seven months later, a repeat coronary angiogram showed patent SVG
to RCA.
Conclusions: High morbidity and mortality have been reported with CE. This makes surgeons tend not to endarterectomize the diffusely
diseased RCA and most prefer not to bypass this artery in such situation. On the other hand, many studies showed accepted safety with
CE with no increase hospital mortality have been reported. Combined RCA CE with coronary artery bypass grafting had favorable outcome
in previous series and one study demonstrated no statistically significant mortality and morbidity differences in one study comparing RCA
EC to bypass than these without RCA CE. Finally, CE offers an alternative option of coronary artery reconstruction and revascularization
when technically unable to construct distal anastomosis.
Conclusions: RCA endarterectomy can offer satisfactory result for patients with diffused coronary artery disease. As there is no uniform
agreement amongst surgeons in the field of CE, a large prospective trial is needed to establish guidance and outcomes.

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