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Outcomes of Patients Undergoing Closed Traction CoronaryEndarterectomy: A Long-Term Single Center Study
Sharaf-Eldin Shehada1, Fanar Mourad1, Ali Haddad2
1West German Heart and Vascular Centre, Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany.
Insights
Coronary endarterectomy (CEA) combined with coronary artery bypass grafting (CABG) offers a viable option for severe coronary artery disease, demonstrating satisfactory short- and long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary endarterectomy (CEA) is an underutilized procedure for complex coronary artery disease (CAD).
- Surgeons often avoid CEA due to perceived complexity and variable outcomes.
- This study reviews CEA outcomes when performed concurrently with coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the clinical outcomes of patients undergoing CEA during CABG surgery.
- To assess the safety and efficacy of CEA in achieving complete revascularization for severe, diffuse CAD.
- To analyze early and long-term results, including survival and major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- Retrospective observational study of 326 patients undergoing CEA within CABG (March 2003 - February 2018).
- Data collected on patient demographics, disease severity (SYNTAX score), and procedural details.
- Long-term follow-up assessed mortality, myocardial infarction, stroke, and MACCE.
Main Results:
- 326 patients (mean age 67, 88% male) with severe CAD underwent 394 CEAs.
- Early outcomes: 2.4% perioperative myocardial infarction, 2.4% stroke, 4.0% in-hospital mortality.
- Ten-year follow-up: 27.6% mortality and 41.4% MACCE incidence.
Conclusions:
- CEA is a valuable technique for achieving complete revascularization in complex CAD, especially with chronic occlusions.
- The closed traction CEA technique yields satisfactory short- and long-term results.
- CEA provides a crucial option for patients unsuitable for standard CABG alone.
Abstract:
Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% (n = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally (n = 111, 28.2%) or sub-totally (n = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.
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