Does Coronary Endarterectomy Increase Early Mortality and Morbidity Compared with Coronary Artery Bypass Surgery Alone-Single Centre Experience

Abstract

Background: With increasing incidence of coronary artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has resulted in a more complex pool of cases referred to cardiac surgeons. In selected cases, achieving optimal revascularization of diffuse CAD necessitates adjunctive techniques such as coronary endarterectomy (CE). The aim of our study is to evaluate the early mortality and post-operative morbidity related to CE. Method: Retrospective study from Jan 2009 to Dec 2010. Inclusion of 186 patients: 38 patients had CABG with CE and 148 patients had CABG alone. Results: Pre-operative percutaneous coronary intervention (PCI) was higher in the CE with CABG group (25.8%) compared with CABG alone (8.9%) (p = 0.009). Intra-operative data showed a higher mean cardiopulmonary bypass time (CBT) of 160 minutes and a mean cross-clamp time (XCT) of 109 minutes in the CE with CABG, compared to a mean CBT of 129 minutes and a mean XCT of 87 minutes in the CABG alone group (p = 0.001). The most common vessel endarterectomized was left anterior descending artery (LAD) (47%) followed by right coronary artery (RCA) (22%). Post-operatively, the mortality amongst the CE with CABG group (7.9%) was higher than CABG only group (1.4%), however it wasn't statistically significant (p = 0.06). With regards to morbidity, hemodynamic instability requiring intra aortic balloon pump (HIR-IABP) was higher in the CE with CABG group (10.5%) compared to the CABG only group (1.4%) (p = 0.018). Conclusion: Our study showed that CE when combined with CABG wasn't associated with a higher mortality rate when compared with CABG alone.

The Impact of Common Comorbidities on the Cardiopulmonary Rehabilitation Outcomes and Cost of Care for Post-CABG Surgery Patients<br /> <div> <br /> </div>

“…Currently, there are no accurate statistics available regarding CABG surgery in KSA. [14,16,17] However, the King Faisal Specialist Hospital and Research Center (KFSH&RC) reported that over 500 CABG surgeries are performed annually [21]. It is assumed that all post-CABG patients in the KSA are offered an early intervention inpatient program (phase I) of Cardiac Rehabilitation postsurgery, as KFSH&RC.…”

“…The prevalence of CHD in the Saudi population has been increasing owing to rapid economic growth [11] and has resulted in an increased demand for cardiac care and rehabilitation [12]. One of the most common solutions for patients with CHD in the KSA is the Coronary Artery Bypass Graft surgery [13], but comorbidities such as diabetes mellitus (DM), hypertension (HTN) peripheral vascular disease (PVD), chronic obstructive pulmonary disease (COPD), peptic ulcer disease, dialysis-dependent renal failure, obesity, and dementia are common among patients undergoing this surgery and can adversely affect their outcome [14,15]. The focus of coronary artery bypass (CABG) research has been shifted from investigating mortality and morbidity to investigating patients' physical and mental health [16,17] including their health-related quality of life [18,19].…”