Effects of coronary endarterectomy on postoperative early results in long segment coronary artery disease

Abstract

Objectives: Main goal of coronary bypass surgery is complete revascularization. In some coronary endarterectomy applied patient groups, complete revascularization is inevitable. In this study, it was aimed to reveal factors affecting early mortality and morbidity in patients undergoing coronary endarterectomy.

Methods: Retrospective records of preoperative, operative, and postoperative data of 98 patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy between January 1, 2012, and October 30, 2016, were reviewed.

Results: A total of 113 endarterectomies were performed in different coronary arteries. Of the patients, 22 (22.4%) were female and 76 (77.6%) were male. The mean of ages was 60.4 ± 9.9 (range; 36-81 years). A positive inotropic requirement was required in 68 (69.1%) patients and intra-aortic balloon pump was required for 23 (23.4%) patients. Mortality was observed in 10 patients (10.2%). Peroperative myocardial infarction was observed in 17 (17.3%) patients. Mortality rate was significantly higher in patients whose left ventricular ejection fraction was 30 or less and who had a higher risk in EuroSCORE (p < 0.001). When compared with the other vessels, mortality ratewas found to be higher for left anterior descending coronary artery endarterectomy (p = 0.038). Mortality in female patients undergoing endarterectomy was higher than male patients (p = 0.023).

Conclusions: Mortality and morbidity are higher in patients undergoing coronary endarterectomy when compared to conventional CABG operations. However, it is a method that can be applied by considering certain risk factors. 

Keywords

• Endarterectomy,bypass surgery,coronary artery

References

1. 1. Nishigawa K, Fukui T, Takanashi S. Coronary endarterectomy for the diffusely diseased coronary artery. Gen Thorac Cardiovasc Surg 2014;62:461-7.
2. 2. Soylu E, Harling L, Ashrafian H, Athanasiou T. Does coronary endarterectomy technique affect surgical outcome when combined with coronary artery bypass grafting? Interact Cardiovasc Thorac Surg 2014;19:848-55.
3. 3. Bailey CP, May A, Lemmon WM. Survival after coronary endarterectomy in man. JAMA 1957;164:641-6.
4. 4. Shapira OM, Akopian G, Hussain A, Adelstein M, Lazar LH, Aldea GS, et al. Improved clinical outcomes in patients undergoing coronary artery bypass grafting with coronary endarterectomy. Ann Thorac Surg 1999;68:2273-8.
5. 5. Ghatanatti R, Teli A. Coronary endarterectomy: recent trends. J Clin Diagn Res 2017;11:PE01-PE04.
6. 6. Bagheri A, Masoumi A, Bagheri J. Early outcomes of coronary endarterectomy in patients undergoing coronary artery bypass surgery. Heart Surg Forum 2016;19:E059-63.
7. 7. Gucu A, Goncu T, Yavuz S, Arican Özluk O, Eris C, Turk T, et al. Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing complete myocardial revascularization. Int J Clin Exp Med 2014;7:142-7.
8. 8. Takanashi S, Fukui T, Miyamoto Y. Coronary endarterectomy in the left anterior descending artery. J Cardiol 2008;52:261-8.

9. 9. Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: the current state of knowledge. Atherosclerosis 2016;249:88-98.
10. 10. Schmitto JD, Kolat P, Ortmann P, Popov AF, Coskun KO, Friedrich M, et al. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease. J Cardiothorac Surg 2009;4:52.
11. 11. Padhy K, Narasimham SBR, Murthy GSRC, Chaganti VR, Kumar PVVNM, Rao MB, et al. Coronary endarterectomy for diffuse extensive coronary artery disease. Ind J Thoracic Cardiovasc Surg 2005;21:251-5.
12. 12. Yener Ümit A, Kervan Ü, Korkmaz K, Gedik Selçuk H, Budak Baran A, Genç Bahadır S, et al. The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting. Turk Gogus Kalp Dama 2014;22:734-41.
13. 13. Byrne JG, Karavas AN, Gudbjartson T, Leacche M, Rawn JD, Couper GS, et al. Left anterior descending coronary endarterectomy: early and late results in 196 consecutive patients. Ann Thorac Surg 2004;78:867-73.
14. 14. Sirivella S, Gielchinsky I, Parsonnet V. Results of coronary artery endarterectomy and coronary artery bypass grafting for diffuse coronary artery disease. Ann Thorac Surg 2005;80:1738-44.
15. 15. Fuster V. Epidemic of cardiovascular disease and stroke: the three main challenges. Circulation 1999;99:1132-7.
16. 16. Jones EL, Weintraub WS. The importance of completeness of revascularization during long-term follow-up after coronary artery operations. J Thorac Cardiovasc Surg 1996;112:227-37.
17. 17. Tiruvoipati R, Loubani M, Lencioni M, Ghosh S, Jones PW, Patel RL. Coronary endarterectomy:impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg 2005;79:1999-2003.