Coronary Endarterectomy: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Surgical Techniques

Background:

• Coronary endarterectomy (CE) is an infrequent, often unplanned, surgical technique used in complex cases during coronary artery bypass grafting (CABG).
• The study evaluates the outcomes of CE combined with CABG (CE-CABG) using a large national cardiac surgery database.

Purpose of the Study:

• To assess the operative and long-term outcomes of CE-CABG compared to standard CABG.
• To establish a benchmark for the expected results of this rare procedure.

Main Methods:

• Retrospective review of isolated, first-time CABG cases from July 2011 to September 2019 in The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
• Propensity score matching was employed to account for the higher-risk profile of patients undergoing CE-CABG.
• Primary outcomes included operative mortality and myocardial infarction; long-term mortality and rehospitalization were assessed for patients aged 65+ using linked Medicare data.

Main Results:

• Out of 1,111,792 patients, 2.9% underwent CE-CABG. The majority involved single-vessel endarterectomy, most commonly on the left anterior descending artery.
• CE-CABG was associated with significantly increased operative mortality (3.2% vs. 1.7%) and postoperative myocardial infarction (6.8% vs. 3.9%) compared to propensity score-matched CABG alone.
• While CE-CABG showed higher early risks (first year mortality, first three years rehospitalization for MI), outcomes became comparable to CABG alone thereafter. Subgroup analysis revealed no significant difference based on the specific coronary artery treated.

Conclusions:

• CE-CABG, despite higher initial operative risks, demonstrates acceptable long-term results.
• This study provides a crucial benchmark for understanding the expected outcomes when employing coronary endarterectomy during CABG.