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Published on: November 19, 2019
Outcome and graft patency in coronary artery bypass grafting with coronary endarterectomy
Mohammad Hassan Nemati1, Behrooz Astaneh2, Shahdad Khosropanah3
1Cardiac Surgery Department, Medical School, Shiraz University of Medical Sciences.
Insights
Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) shows similar complication rates to CABG alone for severe coronary artery disease. Endarterectomized vessels demonstrate good patency, supporting CE as a viable option.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary endarterectomy (CE) use in severe coronary artery disease remains debated.
- Comparison of comorbidities and perioperative factors between coronary artery bypass grafting (CABG) with and without CE is crucial.
Purpose of the Study:
- To compare comorbidities and perioperative characteristics of patients undergoing CABG with and without CE.
- To evaluate the safety and efficacy of CE in patients with severe coronary artery disease.
Main Methods:
- Retrospective study of 967 patients undergoing CABG without CE and 84 patients undergoing CABG with CE (CE+ group).
- Follow-up included angiography in 28 CE+ patients to assess graft and native vessel patency.
- Data collected on comorbidities, perioperative characteristics, hospital mortality, and vessel patency.
Main Results:
- CE+ group had higher prevalence of diabetes and more diseased vessels.
- Overall hospital mortality was 1.8% with no significant difference between groups.
- 66% patency rate observed in endarterectomized vessels; left internal mammary artery grafts showed better patency than saphenous vein grafts.
Conclusions:
- CE does not appear to increase postoperative complication risk compared to CABG alone.
- CE is a viable option for severely diseased vessels, with demonstrated patency in follow-up studies.
- Further research may elucidate optimal patient selection for CE combined with CABG.
Background:
Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE.
Methods:
This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66±3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels.
Results:
Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88±0.39 vs. 2.70±0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used.
Conclusion:
The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.
