Coronary endarterectomy (CE) may provide an useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffusely coronary artery disease. Nevertheless, the incidence of complications remains still high, long-term results remain unclear, and no risk factors for late mortality have been still completely described.
We retrospectively reviewed 90 consecutive patients (67 ± 8.2 years) undergoing isolated CABG in association with CE between. Mean follow-up was 75.1 ± 36.2 months (median 84 months) and it was 100% complete (6,755/6,755 pt-months).
Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-years survival was 83.3% ± 4.1%, freedom from cardiac death 92.7% ± 2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2% ± 10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (P = 0.018) and chronic obstructive pulmonary disease (P = 0.036). Ten-year freedom from cardiac death was better after CE on the LAD (93.2% ± 3.3%) in comparison to CE not on the LAD (74.6% ± 10.2%), although this difference did not reach statistical significance (P = 0.102).
Although the incidence of perioperative myocardial infarction continues to be not negligible, in presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. CE on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which focusing attention for the increased risk of late death.
1Department of Cardiac Surgery, Tor Vergata University Policlinic, Rome, Italy Roma
2Department of Cardiac Sugery, Tor Vergata University Policlinic, Rome, Italy Roma