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Early and late outcomes of multiple coronary endarterectomy
Minoru Tabata1, Prem S Shekar, Gregory S Couper
1Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Multiple coronary endarterectomy (MCE) is a viable option for diffuse coronary artery disease. However, outcomes are poor, necessitating careful patient selection for this revascularization technique.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary endarterectomy is an established revascularization method for diffuse coronary artery disease.
- Limited data exists on the outcomes of multiple coronary endarterectomy (MCE).
Purpose of the Study:
- To evaluate the early and late clinical outcomes of multiple coronary endarterectomy (MCE).
Main Methods:
- Retrospective analysis of 58 patients undergoing MCE between January 1992 and June 2006.
- MCE represented 6.5% of all coronary endarterectomies during the study period.
Main Results:
- Operative mortality was 12.1% and perioperative myocardial infarction occurred in 25.9% of patients.
- Median hospital stay was seven days.
- Actuarial five- and 10-year survival rates were 64% and 36%, respectively.
Conclusions:
- Multiple coronary endarterectomy (MCE) can be considered for revascularizing multiple diffuse coronary artery territories.
- The relatively poor early and late outcomes underscore the need for careful consideration of MCE indications.
Objectives:
Coronary endarterectomy has been shown to be an effective adjunctive technique of revascularization for diffuse coronary artery disease. However, outcomes of multiple coronary endarterectomy (MCE) have not been well investigated. We sought to examine early and late results of this technique.
Methods:
Between January 1992 and June 2006, 58 consecutive patients underwent coronary endarterectomy in more than one coronary artery territories, representing 6.5% of total coronary endarterectomy during the same period. Early and late outcomes were retrospectively analyzed.
Results:
The mean age was 64 years. Forty-one patients (70.7%) had coronary endarterectomy in the left anterior descending artery and right coronary artery territories; five (8.6%) in the left anterior descending artery and circumflex artery territories; eight (13.8%) in the circumflex artery and right coronary artery territories; and four (6.9%) in the left anterior descending artery, circumflex artery, and right coronary artery territories. Operative mortality was 12.1% (7/58). The incidence of perioperative myocardial infarction was 25.9% (15/58). The median length of hospital stay was seven days. Actuarial five- and 10-year survivals were 64% and 36%, respectively.
Conclusions:
MCE may be a reasonable option for revascularization of multiple diffuse coronary artery disease. However, early and late outcomes are relatively poor and the indication should be carefully considered.
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