ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting
Ali Ümit Yener1, Ümit Kervan2, Kemal Korkmaz3, Hikmet Selçuk Gedik3, Ali Baran Budak3, Serhat Bahadır Genç3, M. Turgut Alper Özkan1, İrfan Taşoğlu2, Mustafa Paç2
Department of Cardiovascular Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
1Department of Cardiovascular Surgery, Medical Faculty of Çanakkale Onsekiz Mart University, Çanakkale, Turkey
2Department of Cardiovascular Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
3Department of Cardiovascular Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2014.9883
Background: This study aims to investigate the effect of coronary endarterectomy (CE) on morbidity and mortality in patients undergoing concomitant coronary artery bypass grafting (CABG).

Methods: We retrospectively reviewed 587 patients who underwent CABG surgery with concomitant CE (CABG+CE group) and patch plasty between March 2000 and April 2010. We compared these patients with randomly selected 600 patients who had undergone CABG surgery without CE (CABG only group) in the same period. A comprehensive evaluation of the groups was achieved by subgroup analysis with large series of parameters from patient files.

Results: The patients in the CABG+CE group were older than the patients in the CABG only group (59.6±10.3 vs. 61.3±7.3; p<0.001). The incidence of atherosclerotic risk factors, triplevessel disease, and complaints of unstable angina pectoris were slightly higher in CABG+CE group (p<0.05). Concomitant CE prolonged cross-clamp and cardiopulmonary bypass time. Also, postoperative total entubation time (12±10.3 vs. 12±7.4 hours; p<0.05) was significantly longer (p<0.05). The rates of myocardial infarction (p=0.006) and intra-aortic balloon pump requirement (p<0.001) were significantly higher in the CABG+CE group. The mortality rate did not differ between the two groups.

Conclusion: Indication for CE must still be handled restrictively. Endarterectomy should be performed only on occluded, nearly occluded, and/or severely calcified vessels with long-range stenosis if regular anastomoses to these vessels seem to be technically impossible. Endarterectomy should not be considered as a substitute for CABG, and should be performed by an experienced surgical team. However, CE might not be associated with additional mortality compared to conventional coronary bypass surgery.

Keywords : Coronary vessels; endarterectomy; follow-up studies; morbidity; mortality
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