Coronary endarterectomy for severe diffuse coronary artery disease
Ali Gohar Zamir1, Afsheen Iqbal, Syed Afzal Ahmad
1Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Health Diseases, Rawalpindi. aligoharzamir488@hotmail.com
Summary
Coronary endarterectomy (CE) as an adjunct to coronary artery bypass graft (CABG) surgery offers acceptable risks for diffuse coronary artery disease. This procedure provides satisfactory one-year survival and significant angina relief for patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Diffuse coronary artery disease (CAD) poses challenges for conventional coronary artery bypass graft (CABG) surgery.
- Coronary endarterectomy (CE) is explored as an adjunct procedure for complex CAD cases.
- Evaluating the efficacy and safety of CE in conjunction with CABG is crucial for patient management.
Purpose of the Study:
- To assess the outcomes of Coronary Endarterectomy (CE) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery for diffuse Coronary Artery Disease (CAD).
- To evaluate postoperative mortality, morbidity, angina relief, and one-year survival rates following CE combined with CABG.
- To determine the feasibility of CE as an adjunct to CABG in complex diffuse CAD.
Main Methods:
- A case series study was conducted involving patients with diffuse CAD unsuitable for conventional bypass grafting.
- Exclusion criteria included akinetic myocardium, poor left ventricular function, severe hepatic or immune deficiency, and poor lung function.
- Cardiopulmonary Bypass (CPB) was utilized in all procedures, with a mean follow-up of one year for outcome assessment.
Main Results:
- Fifty-five patients underwent CE for severe diffuse CAD; 47.3% had prior myocardial infarction, and 29.1% had unstable angina.
- Early mortality was 3.6%, with 3.6% experiencing non-fatal infarctions and 5.4% developing low cardiac output postoperatively.
- At one-year follow-up, no late deaths were recorded, and 91.5% of patients reported significant angina relief (CCS class II/III).
Conclusions:
- Coronary Endarterectomy (CE) serves as a viable adjunct to Coronary Artery Bypass Graft (CABG) surgery for selected patients with diffuse CAD.
- The procedure demonstrated acceptable operative risks, including low early mortality and morbidity.
- Satisfactory one-year outcomes were observed, characterized by high survival rates and substantial improvement in angina symptoms.
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