TITLE:
Does Coronary Endarterectomy Increase Early Mortality and Morbidity Compared with Coronary Artery Bypass Surgery Alone-Single Centre Experience
AUTHORS:
Mohammed Alreshidan, Mohammed Albabtain, Hamoud Obied, Mohamed Alassal, Abdulaziz Albaradai, Fahad Alghofaili
KEYWORDS:
CABG; Coronary Endarterectomy; Mortality; Morbidity
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.5,
March
14,
2014
ABSTRACT: Background: With increasing incidence of coronary
artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has
resulted in a more complex pool of cases referred to cardiac surgeons. In
selected cases, achieving optimal revascularization of diffuse CAD necessitates
adjunctive techniques such as coronary endarterectomy (CE). The aim of our
study is to evaluate the early mortality and post-operative morbidity related
to CE. Method: Retrospective study from Jan 2009 to Dec 2010. Inclusion of 186
patients: 38 patients had CABG with CE and 148 patients had CABG alone.
Results: Pre-operative percutaneous coronary intervention (PCI) was higher in
the CE with CABG group (25.8%) compared with CABG alone (8.9%) (p = 0.009). Intra-operative data showed a higher mean
cardiopulmonary bypass time (CBT) of 160 minutes and a mean cross-clamp time (XCT) of 109
minutes in the CE with CABG, compared to a mean CBT of 129 minutes and a mean XCT of 87 minutes in the CABG alone group (p = 0.001).
The most common vessel endarterectomized was left
anterior descending artery (LAD) (47%) followed by right coronary artery (RCA)
(22%). Post-operatively, the mortality amongst the CE with CABG group (7.9%)
was higher than CABG only group (1.4%), however it wasn’t statistically
significant (p = 0.06). With regards to morbidity, hemodynamic instability
requiring intra aortic balloon pump (HIR-IABP) was higher in the CE with CABG
group (10.5%) compared to the CABG only group (1.4%) (p = 0.018). Conclusion: Our
study showed that CE when combined with CABG wasn’t associated with a higher
mortality rate when compared with CABG alone.