Related Experiment Videos
Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Midterm Outcomes
Ahmed Hasan1,2, Mohamed Gad1, Yasser Mubarak1,3
1Minia Cardiothoracic University Hospital, Minia University, Cardiothoracic Surgery Department, Egypt, Minia.
The Thoracic and Cardiovascular Surgeon
|July 27, 2026
Summary
Coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) shows similar midterm outcomes to CABG alone for diffuse coronary artery disease. Risk factors for complications in the CE group include female sex, renal impairment, peripheral vascular disease, and age over 65.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Diffuse coronary artery disease (CAD) presents challenges for complete revascularization, especially with small or diseased vessels.
- Coronary endarterectomy (CE) offers a potential solution for complex cases where standard bypass grafting is not feasible.
- The impact of combining CE with coronary artery bypass grafting (CABG) on patient outcomes remains a subject of debate.
Purpose of the Study:
- To evaluate the midterm outcomes of patients undergoing CABG with concomitant CE compared to CABG alone.
- To identify potential risk factors associated with adverse events in patients who underwent CE as part of their CABG procedure.
Main Methods:
- A retrospective cohort study included 406 patients from 2017-2022, with 97 undergoing CE and CABG, and 309 undergoing CABG-only.
- The primary endpoint was major adverse cardiovascular events (all-cause mortality or myocardial infarction) assessed up to 72 months post-procedure.
- Risk modeling within the CE subgroup utilized Firth penalized logistic regression, with time-to-event analyses performed using Kaplan-Meier methods.
Main Results:
- No significant differences in early perioperative myocardial infarction or in-hospital mortality were observed between the CE and CABG-only groups.
- Overall survival at 72 months was similar between the two groups (log-rank p=0.289).
- Within the CE cohort, midterm rates of myocardial infarction (1.0%) and stroke (2.1%) were low. Renal impairment, female sex, peripheral vascular disease (PVD), and age ≥65 were independently associated with complications.
Conclusions:
- Selective use of CE with CABG provides comparable early and midterm results to CABG-only, with a low rate of midterm complications.
- Specific patient subgroups, including women, those with renal impairment or PVD, and individuals aged 65 and older, face higher risks.
- These findings support the need for increased perioperative vigilance and individualized follow-up strategies for high-risk patients undergoing CE with CABG.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...