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Coronary endarterectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery
Ravindranath Tiruvoipati1, Mahmoud Loubani, Mauro Lencioni
1Department of Cardiothoracic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry, United Kingdom. travindranath@hotmail.com
Insights
Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) showed higher mortality, but this was linked to patient comorbidities, not the CE procedure itself. Further analysis confirmed CE is not a predictor of mortality.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes
- Cardiac Procedures
Background:
- The efficacy of combining coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) remains debated.
- This study evaluates the impact of adding CE to CABG versus CABG alone within a specific clinical unit.
Purpose of the Study:
- To compare outcomes between patients undergoing CABG alone and those receiving both CABG and CE.
- To determine if CE, when added to CABG, influences perioperative complications and early mortality.
Main Methods:
- A retrospective analysis of 5,782 patients who underwent CABG between January 1995 and December 2001.
- Patients were divided into two groups: CABG-only and CABG with CE.
- Key outcomes assessed included perioperative myocardial infarction, arrhythmias, stroke, renal impairment, and mortality.
Main Results:
- Of 5,782 CABG patients, 461 (8.6%) also underwent CE.
- The CABG with CE group had higher mortality and postoperative renal impairment.
- However, propensity score analysis indicated CE itself was not a predictor of increased mortality, with comorbidities being the primary drivers.
Conclusions:
- While combined CE and CABG appeared associated with higher mortality in initial analysis, this was attributed to patient comorbidities.
- CE was not identified as an independent predictor of mortality in this cohort.
- The findings suggest careful patient selection is crucial when considering CE in conjunction with CABG.
Background:
The results of coronary endarterectomy (CE) performed in addition to coronary artery bypass grafting (CABG) have been controversial. We aimed to examine the impact of CE performed in addition to CABG when compared with CABG alone in our unit.
Methods:
Patients who had CABG between January 1995 and December 2001 were included. They were divided into two groups, the CABG-only group and CABG and CE group. The following outcomes were compared: perioperative myocardial infarction, postoperative ventricular arrhythmias, cerebrovascular accident, renal impairment, and early mortality.
Results:
Of 5,782 patients who underwent CABG, 461 patients (8.6%) required CE in addition to CABG. There was a higher mortality and incidence of postoperative renal impairment in the group of patients who had CABG and CE, with no significant difference in other outcomes. However, the patients in the CABG and CE group had a higher incidence of male sex, previous myocardial infarctions, preoperative renal impairment, and poor left ventricular function, with longer cross-clamp and cardiopulmonary bypass times than in the CABG-only patients. Although female sex, renal impairment, nonelective surgery, impaired left ventricular function, and peripheral vascular disease were associated with increased mortality in all the patients, and use of statins and aspirin was associated with a reduction in mortality, CE was not a predictor of mortality. Furthermore, on propensity scores analysis, CE was not associated with increased mortality.
Conclusions:
Coronary endarterectomy when combined with CABG seemed to be associated with a higher mortality than isolated CABG in our study groups, but this is related to comorbidities of these patients rather than the CE.
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