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

Abstract

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.

Comparison of Isolated Coronary Artery Bypass Grafting with Open Coronary Endarterectomy Followed by Coronary Artery Revascularization

“…This result was similar to the result reported in the literature. 1,4,10,11 Additionally, angiographic results were significantly in favor of open endarterectomy in midterm period. 12 After control coronary angiography; stenoses or occlusion free anastomoses have been found 76.1% of patients with long arteriotomy and on-lay patch anastomoses in a mean 20 months whereas 38.1% of the patients with short arteriotomy and closed traction method in a mean 24 months.…”

“…In literature; higher percentage of left ventricular dysfunctions in patients with endarterectomy as seen in our study or similar ventricular functions in patients with or without endarterectomy have been reported. 1,3,7,9,10 Although the patients with left ventricle dysfunction was higher in the Group-1, low mortality rates were seen in both groups. As taken into consider the high percentage of women patients and diabetes for both groups, which were well-known two preoperative risk factors, this result is thought to be related to the myocardial protection provided by the application of retrograde blood cardioplegia besides the effectiveness of endarterectomy.…”

“…3,7,11 It has been stated that longer duration of ICU stay in endarterectomy patients are related to lung injury and prolonged intubation time due to longer operation time. 1 The present study did not investigate the prolonged mechanical ventilation time and inotrope usage. On the other hand, the average drainage amounts and intra-aortic balloon pump usage rates were similar in both groups.…”

“…In the literature the early mortality rates after coronary endarterectomy has been reported as 2.8-6%, which is similar to the present study results. [1][2][3][4][5][6][7]9 Open endarterectomy and long-segment anastomosis were preferred in all cases of the Group-1. Use of both close and open endarterectomy technique in the same series successfully has been demonstrated.…”

Modern trends in coronary surgery

“…Часть хирургов демонстрируют хорошие результаты эндар-терэктомий, сопоставимые с показателями стандартного коронарного шунтирования [51].…”