Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease
Priyadharshanan Ariyaratnam1, Kalyana Javangula, Sotiris Papaspyros
1Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK. priyadariyaratnam@yahoo.co.uk
Insights
Coronary endarterectomy (CE) as an adjunct to coronary artery bypass grafting (CABG) shows significant long-term survival in complex coronary artery disease. This 20-year study confirms CE
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) has advanced, leading to debate on the role of coronary endarterectomy (CE).
- Complex coronary artery disease cases require re-evaluation of adjunctive surgical strategies.
- Long-term outcomes of CE remain largely unknown.
Purpose of the Study:
- To evaluate the long-term results of coronary endarterectomy (CE) as an adjunct to coronary artery bypass grafting (CABG).
- To analyze a 20-year single-institution experience with CE in diffuse coronary artery disease.
Main Methods:
- Retrospective analysis of prospectively collected data from 801 patients undergoing CE between 1988 and 2010.
- Standard open hydrodissection technique used by a single surgeon.
- Cox's regression analysis to identify predictors of long-term survival.
Main Results:
- Mean patient age was 63.2 years; 1.16 coronary arteries underwent endarterectomy per patient.
- Operative mortality was 2.62%. Median survival time was 16.67 years.
- Predictors of survival included younger age, lower EuroSCORE I, absence of peripheral vascular disease, and shorter bypass times.
Conclusions:
- Coronary endarterectomy (CE) can be an effective adjunct to CABG for patients with otherwise inoperable coronary artery disease.
- Significant long-term survival observed supports the continued use of CE in select cases.
Objectives:
The role of coronary endarterectomy (CE) in modern cardiac surgery has been an extant debate as coronary artery bypass grafting (CABG) has advanced. However, as cardiac surgeons are being referred ever more complex coronary disease for surgical correction, adjunctive strategies may need re-evaluation. The long-term results of CE are largely unknown. We present the longest cohort follow-up in a single institution looking at our 20-year experience of CEs employed as an adjunct to CABG in diffuse coronary artery disease.
Methods:
We performed retrospective analysis of data collected prospectively on 801 patients undergoing CEs between February 1988 and September 2010 by a single surgeon using a standard open hydrodissection technique. We looked at patient demographics, characteristics of the vessels subjected to endarterectomy and predictors of long-term survival within this surgical group using Cox's regression analysis.
Results:
The mean age was 63.2 (±9.6) years. The mean number of coronary arteries undergoing endarterectomy was 1.16 (±0.4) per patient. Of these, 63.7% were performed on the right coronary artery (n = 558) and 32.3% on the left anterior descending artery (n = 283). The operative mortality was 2.62% (n = 21). The median survival time was 16.67 years (95% confidence interval 15.14-18.19 years). The significant predictors of survival (P < 0.05) were a lower age at surgery, a lower EuroSCORE I, the absence of peripheral vascular disease and shorter bypass times.
Conclusion:
This significant long-term survival demonstrates that CE can be an attractive adjunct to CABG in otherwise inoperable coronary artery disease.
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