Early postoperative results of on-pump coronary endarterectomy: is it still a controversy?

Year 2021, , 248 - 255, 04.05.2021

Cüneyt Eriş , Umut Serhat Sanrı , Mesut Engin , Senol Yavuz

https://doi.org/10.18621/eurj.904571

Cited By: 3

Abstract

Objectives: The coronary endarterectomy combined with coronary artery bypass grafting (CABG) is an useful but still controversial surgical technique in diffuse coronary artery disease. The aim of this study was to analyze the operative and early postoperative outcomes of the patients who underwent CABG with and without coronary endarterectomy.

Methods: This retrospective study included a total of 312 consequtive patients undergoing on-pump CABG from December 2018 to December 2020 in the Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital. Patients were divided into 2 groups as those who underwent coronary endarterectomy combined with on-pump CABG (Group 1, n = 48) and those who underwent isolated on-pump CABG (Group 2, n = 264). Peroperative variables were obtained from our hospital's computerized database and retrospectively analyzed.

Results: Previous percutaneus coronary intervention rate and the number of patients with diabetes mellitus was significantly higher in the endarterectomy group. The demographics and characteristics of the patients were similar between the two groups. The median number of distal anastomoses was 4 (2-5) in Group 1 and 2 (1-5) in Group 2. Median cross-clamp duration and perfusion times in Group 1 were longer than Group 2 (82 min vs. 63 min; p < 0.001 and 120 min vs. 95 min; p = 0.003, respectively). A total of 54 coronary endarterectomy practices were performed on 48 patients, and the LAD artery (73%) was the most endarterectomized vessel. In Group 1, postoperative 24 hours high-sensitive troponin I levels were significantly higher than in Group 2 (p < 0.001). There was no significant difference between the groups in terms of operative mortality, low cardiac output rates and perioperative myocardial infarction rates. Postoperative atrial fibrillation was significantly higher in Group 1 (p = 0.023).

Conclusions: Although coronary endarterectomy is a complex procedure, in patients with diffuse coronary artery disease, it is an essential and sometimes mandotary method in order to achieve complete revacularization and can be performed safely with acceptable operative and early postoperative outcomes.

Keywords

Diffuse coronary artery disease, Complete myocardial revascularization, Coronary endarterectomy, postoperative period

References

• 1. Yap CH, Yan BP, Akowuah E, Dinh DT, Smith JA, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv 2009;2:758-64.
• 2. Kleisli T, Cheng W, Jacobs MJ, Mirocha J, Derobertis MA, Kass RM, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2005;129:1283-91.
• 3. Zimarino M, Ricci F, Romanello M, Di Nicola M, Corazzini A, et al. Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: A meta-analysis of randomized and observational studies. Catheter Cardiovasc Interv 2016;87:3-12.
• 4. Papakonstantinou NA, Baikoussis NG, Apostolakis E Coronary endarterectomy: new flavors from old recipes. J Cardiol 2014:63: 397-401.
• 5. Güvenç O, Göncü MT, Engin M, Çayır MÇ, Özyazıcıoğlu AF. Effects of coronary endarterectomy on postoperative early results in long segment coronary artery disease. Eur Res J 2020;6:187-92.
• 6. Marinelli G, Chiappini B, Di Eusanio M, Di Bartolomeo R, Caldarera I, Marrozzini C, et al. Bypass grafting with coronary endarterectomy: immediate and long-term results. J Thorac Cardiovasc Surg 2002;124:553-60.
• 7. Livesay JJ, Cooley DA, Hallman GL, Reul GJ, Ott DA, Duncan JM, et al. Early and late results of coronary endarterectomy: analysis of 3,369 patients. J Thorac Cardiovasc Surg 1986;92:649-60.
• 8. Russo M, Nardi P, Saitto G, Bovio E, Pellegrino A, Scafuri A, et al. Single versus double antiplatelet therapy in patients undergoing coronary artery bypass grafting with coronary endarterectomy: mid-term results and clinical implications. Interact Cardiovasc Thorac Surg 2017;24:203-8.
• 9. Tiruvoipati R, Loubani M, Peek G. Coronary endarterectomy in the current era. Curr Opin Cardiol 2005;20:517-20.
• 10. 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.
• 11. Santini F, Casali G, Lusini M, D’Onofrio A, Barbieri E, Rigatelli G, et al. A. Mid-term results after extensive vein patch reconstruction andinternal mammary grafting of the diffusely diseased left anterior descendingcoronary artery. Eur J Cardiothorac Surg 2002;21:1020-5.
• 12. Bailey CP, May A, Lemon WM. Survival after coronary endarterectomy in man. J Am Med Assoc 1957;164: 641-6.
• 13. 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.
• 14. Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: the current state of knowledge. Atherosclerosis 2016;249:88-98.
• 15. Wang J, Gu C, Yu W, Gao M, Yu U. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: a meta-analysis of 63,730 patients (PRISMA). Medicine (Baltimore) 2015;94:e1781.
• 16. Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg 2014;19:462-73.
• 17. Takanashi S, Fukui T, Miyamoto Y. Coronary endarterectomy in the left anterior descending artery. J Cardiol 2008;52:261-8.
• 18. Takahashi M, Gohil S, Tong B, Lento P, Filsoufi F, Reddy RC. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg 2013;16:301-5.
• 19. Nishi H, Miyamoto S, Takanashi S, Minamimura H, Ishikawa T, Kato Y, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg 2005;79:846-53.
• 20. Yener AÜ, Kervan Ü, Korkmaz K, Gedik HS, Budak AB, Genç SB, 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.