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Does coronary endarterectomy increase the risk of coronary bypass?
Shuli Silberman1, Ilia Dzigivker, Ofer Merin
1Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. cts-szmc@szmc.co.il
Insights
Coronary artery bypass grafting (CABG) with endarterectomy of the left anterior descending (LAD) artery increases operative mortality. However, endarterectomy of other arteries does not significantly increase mortality, though perioperative myocardial infarction risk rises for both groups.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Increasing use of angioplasty and stenting leads to more complex coronary artery disease in patients undergoing coronary bypass surgery (CABG).
- Complete revascularization may necessitate endarterectomy in a growing number of patients.
- This study compares outcomes of CABG with and without endarterectomy.
Purpose of the Study:
- To compare the outcomes of coronary artery bypass grafting (CABG) in patients who underwent endarterectomy versus those who did not.
- To specifically analyze the risks associated with endarterectomy of the left anterior descending (LAD) artery versus other arteries.
Main Methods:
- Retrospective analysis of 2372 patients undergoing isolated CABG between 1993 and 1999.
- Comparison of three groups: LAD endarterectomy (n=88), other artery endarterectomy (n=143), and no endarterectomy (n=2071).
- Exclusion of CABG procedures performed without cardiopulmonary bypass.
Main Results:
- Operative mortality was significantly higher in the LAD endarterectomy group (10%) compared to the no endarterectomy group (3%).
- Mortality in the other artery endarterectomy group (4%) was not significantly different from the no endarterectomy group.
- Perioperative myocardial infarction incidence was elevated in both endarterectomy groups (12% and 8%) compared to the no endarterectomy group (2%).
Conclusions:
- Endarterectomy of the LAD during CABG is associated with increased operative mortality.
- Endarterectomy of arteries other than the LAD does not appear to increase operative mortality.
- Both types of endarterectomy increase the risk of perioperative myocardial infarction.
Background:
With increased incidence of angioplasty and stent implantation, patients referred for coronary bypass (CABG) typically have more advanced and diffuse coronary disease. Thus, more patients may require endarterectomy in order to achieve complete revascularization. We compared our results in patients undergoing CABG with or without coronary endarterectomy.
Methods:
Between 1993 and 1999, 2372 patients underwent isolated CABG in our department. A retrospective analysis was performed to compare patients requiring coronary endarterectomy of the LAD (group 1, n = 88), endarterectomy of arteries other than the LAD (group 2, n = 143), to those not requiring endarterectomy (group 3, n = 2071). Patients undergoing CABG without the use of cardiopulmonary bypass were excluded. Group 1 had a higher incidence of proximal LAD stenosis (p = 0.001) than group 3, while group 2 had a higher incidence of peripheral vascular disease (p = 0.02), preoperative MI (p = 0.03) and LV dysfunction (p = 0.001).
Results:
Operative mortality was 10% in group 1 (p < 0.001) and 4% in group 2 (p = NS) compared to 3% in group 3. Incidence of perioperative MI was 12% in group 1 (p = 0.001) and 8% in group 2 (p = 0.001) compared to 2% in group 3.
Conclusions:
Patients requiring endarterectomy of the LAD are at increased risk of operative mortality. This was not true for patients requiring endarterectomy of arteries other than the LAD. In both groups there was an increased risk of perioperative myocardial infarction.