Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

Atik, Fernando Antibas; Dallan, Luís Alberto Oliveira; Oliveira, Sérgio Almeida de; Lisboa, Luiz Augusto Ferreira; Platania, Fernando; Cabral, Richard Haltí; Jatene, Adib

doi:10.1590/s0066-782x2000001000002

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…Furthermore, the observation that 28% of postoperative MIs within CE patients occurred in endarterectomized regions is consistent with results of other reported series 4,12,14 . In fact, perioperative MI remains a primary complication following coronary endarterectomy and is believed to be due to removal of the endothelial lining after performing endarterectomy, resulting in thrombosis 15 . For this reason, we employ dual antiplatelet therapy for all endarterectomy patients.…”

Section: Discussionsupporting

confidence: 86%

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

LaPar

Anvari

Irvine

et al. 2011

Journal of Cardiac Surgery

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Background The impact of coronary artery endarterectomy during coronary artery bypass grafting (CABG) has been debated. We examined the early and late outcomes of CABG with endarterectomy (CE) compared to CABG alone. Methods Patients undergoing isolated CABG operations from 2003 to 2008 were retrospectively reviewed. We identified 99 patients who underwent CE and 3:1 propensity matched them to 297 CABG-alone patients based upon clinical factors: Society of Thoracic Surgeons (STS) predicted risk of mortality, age, gender, year of surgery, and ejection fraction. Patient risk factors as well as short-and long-term outcomes were compared by univariate and Kaplan-Meier analysis. Results Preoperative risk factors were similar between patients undergoing CE or CABG alone. Cross-clamp times (95.6 vs. 71.8 minutes, p = 0.0001) and perfusion times (121.8 vs. 92.7 minutes, p = 0.0001) were longer in patients undergoing CE. Operative mortality (4.0% vs. 1.3%, p = 0.112) and postoperative complications were not significantly different between groups. Patients undergoing coronary endarterectomy incurred longer ICU (75.06 vs. 48.64 hours, p = 0.001) and hospital stays (9.01 vs. 7.7 days, p = 0.034). Long-term mortality (mean follow-up = 27.7 ± 17.7 months) was equivalent despite revascularization technique (p = 0.13); however, patients undergoing CE encountered worse overall freedom from myocardial infarction (MI) (p = 0.03). Conclusion Patients undergoing CABG with coronary CE required longer ventilatory support and ICU stay yet have comparable operative mortality, major complication rates, and long-term survival to isolated CABG. Coronary endarterectomy should be considered an acceptable adjunct to CABG for patients with extensive coronary artery disease to achieve complete revascularization.

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Section: Discussionsupporting

confidence: 86%

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

LaPar

Anvari

Irvine

et al. 2011

Journal of Cardiac Surgery

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“…The cause for myocardial infarction following coronary endarterectomy is attributed to the lack of endothelium in the endarterectomised vessels leading to the thrombosis at the site of endarterectomy [20]. Exposure of subendothelial tissue to the bloodstream leads to the triggering of the coagulation cascade and thrombus formation.…”

Section: Perioperative Myocardial Infarctionmentioning

confidence: 99%

Coronary endarterectomy in the current era

Tiruvoipati

Loubani

Peek³

2005

Current Opinion in Cardiology

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“…Despite the advancement of medical science, the morbidity and mortality following CE with CABG is more prominent than with CABG alone 26 . However, the consequences of the present review are not concordance with these discoveries 25 as in the both study group patients had a lower mortality in our review.In our review, at 1-year survival rate was 98.07% in only CABG group and 97.3% in CE with CABG group and also 90.08% and 88.7% survival rate at 5 years follow up respectively.Djalilian and Shumway reported higher incidence of mortality in patients who had preoperative myocardial infarction 14, 26 . In our review, there was a higher incidence of preoperative MI in patients who required CABG (73.59% in only CABG group and 72% in CE with CABG group), however, CE was not found to be independently associated with mortality in the analysis for the predictors of mortality.Moreover, this mortality was not an aftereffect of the CE, which is also stated by different authors 6,16 .…”

Section: Discussionmentioning

confidence: 97%

Outcome of CABG with or without Coronary Endarterectomy in Bangladesh: A Retrospective Cohort Study

et al. 2018

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Abstract:Objective: In this review, we assess the outcome of surgical revascularization technique, coronary artery bypass grafting (CABG) with or without coronary endarterectomy (CE) for patients with diffuse coronary artery disease in a single surgeon's practice. Results: Of 2189 patients, 1000 patients required coronary endarterectomy in addition to OPCABG. Initially, there was a higher mortality rate and incidence of postoperative blood transfusion in the group of patients who had CE in addition to CABG, with no significant difference in other outcomes. But postoperative use of Heparin, Warfarin and Double antiplatelet agent was associated with decreased mortality significantly in our study. In comparison to other group, the patients in the combined CE with CABG group had a higher incidence of male sex, past MI, and poor left ventricular function. However,emergency CABG, renal impairment, poor left ventricular function, and also peripheral vascular disease were associated with higher mortality in both group of the patients; CE was not a predictor of postoperative mortality. MethodsConclusions: Total surgical revascularization is attainable and accomplishes, when Coronary endarterectomy is performed in addition to Off-pump coronary artery bypass graft in patients when there is no other choice for satisfactory revascularization.

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Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

Cited by 18 publications

References 22 publications

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting

Coronary endarterectomy in the current era

Outcome of CABG with or without Coronary Endarterectomy in Bangladesh: A Retrospective Cohort Study

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