Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy

Abstract

BackgroundControversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE.MethodsThis study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66±3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels.ResultsPatients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88±0.39 vs. 2.70±0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used.ConclusionThe lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.

Coronary Endarterectomy or Patch Angioplasty for Diffuse Left Anterior Descending Artery Disease

“…Data regarding coronary CE have been conflicting and quite extensively debated. Many reports demonstrate better short-and long-term results than previously suggested, [4][5][6][7][8][9] possibly explained by improved surgical methods, modern cardioprotective measures, and better postoperative medical care. Conversely, two recent large meta-analyses 10,11 of patients undergoing CE reported higher rates of early mortality and postoperative complications compared with isolated CABG.…”

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

“…Notwithstanding, recent studies on CE have reported better short-term survival rates ranging from 1.8 to 4%, and lower MACCE rates. 17,18 A contemporary study from China 19 reported 30-day mortality rates at 1.4% and perioperative MI rates at 4.1% and a similar study in Germany 20 also reported 30-day mortality of 1.8% and periprocedural MI at 3.6%. In our cohort, the 30-day mortality rate was 2.5% and one-year all-cause mortality was 6.2%.…”

Antithrombotic regimens in patients after coronary artery bypass grafting and coronary endarterectomy

“…Some authors declare that there are no significant differences in postoperative outcomes between two techniques, and thus substantiate the conclusion that CEAE is a competitive option allowing complete revascularization in patients with severely diffuse atherosclerosis. (Nemati et al 2015) Quite the opposite are the results of almost the same number of studies published by other authors reporting elevated mortality rates and complications in endarterectomized versus conventionally revascularized patients, and recommend only a limited number of cases with severe restrictive indications. (Bernal-Aragón et al 2015) Byrne et al (2004) found that, because of the large area of destroyed endothelium of target vessel during CEAE, ASA monotherapy was not sufficient to provide long-term bypass patency.…”