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Coronary Endarterectomy: Recent Trends

Ravi Ghatanatti1, Anita Teli2

  • 1Consultant Cardiac Surgeon, Department of Cardiothoracic and Vascular Surgery, KLE's Dr Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India.

Journal of Clinical and Diagnostic Research : JCDR
|October 4, 2017
PubMed

Insights

Coronary endarterectomy (CE) offers complete myocardial revascularization for diffuse coronary artery disease. Despite concerns about morbidity, evidence supports its use in specific cardiac surgeries, improving outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Techniques

Background:

  • Coronary endarterectomy (CE) is increasingly utilized as an adjuvant procedure in Coronary Artery Bypass Grafting (CABG).
  • Concerns exist regarding the morbidity and mortality associated with CE, leading to ongoing debate about its efficacy.
  • Current evidence suggests CE is beneficial in specific contexts, such as Off-Pump Coronary Artery Bypass (OPCAB) surgery and combined valvular procedures.

Purpose of the Study:

  • To evaluate the current evidence supporting Coronary Endarterectomy (CE) as a routine procedure.
  • To address controversies surrounding the efficiency, morbidity, and mortality of CE.
  • To determine the optimal application of CE in contemporary cardiac surgery.

Main Methods:

  • Review of existing literature and clinical evidence on Coronary Endarterectomy (CE).
  • Analysis of outcomes data comparing CE with other revascularization strategies.
  • Assessment of graft patency and postoperative results associated with different CE techniques.

Main Results:

  • Graft patency is reported to be superior with the open technique for CE.
  • Outcomes remain consistent across various postoperative anticoagulation regimens.
  • CE is particularly supported in Off-Pump Coronary Artery Bypass (OPCAB) surgery and alongside valvular procedures.

Conclusions:

  • Coronary Endarterectomy (CE) can achieve complete myocardial revascularization in diffuse coronary artery disease.
  • While CE faces criticism for higher morbidity and mortality, its role in OPCAB and with valvular procedures is supported by evidence.
  • Further focus on current results is necessary to establish CE as a standard procedure comparable to CABG.

Keywords:
Anticoagulation regimenConduit patencyCoronary artery bypass graftingCoronary revascularization

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