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In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Imran Hussain1, Abdul Ghaffar, Ahmad Shahbaz

  • 1Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore.

Journal of Ayub Medical College, Abbottabad : JAMC
|November 26, 2008
PubMed

Insights

Coronary endarterectomy (CE) is a viable option for complex coronary artery disease, even when performed off-pump. While CE carries higher risks, outcomes are comparable between on-pump and off-pump techniques, demonstrating its feasibility.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Advancements in non-surgical revascularization lead to complex coronary anatomy in surgical candidates.
  • Diffuse atheromatous coronary artery disease necessitates coronary artery reconstruction or endarterectomy (CE).
  • Coronary endarterectomy (CE) requires advanced surgical skill, particularly on a beating heart.

Purpose of the Study:

  • To compare coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) performed on a beating heart versus conventional CABG techniques.
  • To evaluate the feasibility and outcomes of off-pump coronary endarterectomy.

Main Methods:

  • A prospective randomized trial involving 795 patients undergoing CABG from January 2006 to March 2007.
  • 115 patients who underwent coronary endarterectomy (CE) were included in this study.
  • Patients were divided into two groups: on-pump (conventional CABG) and off-pump (beating heart).

Main Results:

  • In-hospital mortality was 5.6% for on-pump and 2.3% for off-pump CE (p=0.649).
  • Post-operative mechanical ventilation duration was 6.78 hours (on-pump) vs. 5 hours (off-pump) (p=0.060).
  • ICU stay was statistically significant (4 days on-pump vs. 4 days off-pump, p=0.02), with higher drain output in the off-pump group (540ml vs. 455ml, p=0.01).

Conclusions:

  • Coronary endarterectomy (CE) is associated with higher post-operative morbidity and mortality.
  • Post-operative outcomes are comparable between on-pump and off-pump CE techniques.
  • CE is feasible using the off-pump technique.
Abstract

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