Study on the coronary endarterectomy combined with electrocautery in the treatment of diffuse coronary artery disease / 中华胸心血管外科杂志

ABSTRACT

Objective:To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting (CABG).Methods:From January 2017 to September 2018, 300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups, after fully informed the risks and other related issues regarding the operations. All the patients in the two groups were treated with CABG. In the study group, patients underwent electrocautery immediately after endarterectomy, whereas in the control group, patients underwent endarterectomy only. The electrocardiogram and serological examination (TNI, IL-6 and TNF-a) were performed at 2 h, 24 h, 72 h and 120 h after operation. The follow-up duration was 1 year.Results:Nine patients in the study group, and 25 patients in the control group had ST segment elevation. The levels of TNI, IL-6 and TNF-a were continuously increased in both groups, and reached the peak at 24 h, then decreased slowly. The levels of TNF-a were significantly lower at 2 h postoperatively in the study group ( P=0.01). There was no significant difference in the levels of TNI and IL-6 between the two groups. The levels of TNI, TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h, 72 h, and 120 h after operation( P<0.05). One year after operation, incidences of ST segment elevation in the study group were significantly lower than that in the control group, and there was no significant difference in restenosis rate and myocardial infarction rate. Conclusion:Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence, smooth the inner wall of the vessel, slow down the release of inflammatory factors in the peripheral blood, inhibit the expression of inflammatory factors in the vessels, and reduce the myocardial damage. The short-term effect was satisfactory; the long-term anti-inflammatory and antithrombotic effect still need further investigations.