Open Coronary Endarterectomy with Coronary Revascularization Provides Similar Midterm Results in Comparison to Isolated Coronary Artery Bypass Grafting without Increasing Early Mortality
Mehmet E. Toker, Babürhan Özbek, Serkan Çelik, Hidayet Demir, İsmail Demir.
Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey.
OBJECTIVE: The coronary endarterectomy combined with coronary artery bypass grafting (CABG) is an effective and well-accepted surgical strategy in diffuse coronary artery disease. This study aimed to analyze the early and mid-term results of the patients who underwent coronary endarterectomy combined with CABG.
METHODS: This retrospective study was conducted between January 2012 and December 2014. A total of 24 patients who underwent open coronary endarterectomy combined with CABG (CABG-CE Group) and also 84 patients who underwent isolated CABG (CABG-Group) were investigated. Technically, following 2-6 cm. long segment arteriotomy, open endarterectomy was made first in open arteriotomy segment. Then, the endarterectomized material was gently held and close endarterectomy was applied in proximal and distal close part of the coronary artery as much length as possible.
RESULTS: The early mortality was similar in both groups (CABG-CE group: 4.2%, CABG group: 4.8%; P = 1.000). The aortic cross-clamping time (ACCT) and total perfusion time (TPT) in the CABG-CE group were longer than those in the CABG group (ACCT: 108.75 min vs. 82.89 min; P = 0.001; TPT: 157.96 min vs. 107.18 min; P = 0.001, respectively. Duration of intensive care unit was longer for the CABG-CE group than that for the CABG group (7.21 days vs. 4.13 days; P = 0.013, respectively). At the end of the follow-up time (CABG-CE Group: 38.96± 3.61 vs. CABG Group: 44.42±1.54 months), the cumulative survival rates including hospital mortality were similar between the two groups (CABG-CE Group: 79.2 ±8.3% vs. CABG group 77.4±7.2%, p = 0.350).
CONCLUSIONS: The open coronary endarterectomy with long arteriotomy is an effective method in early results and midterm outcomes. Coronary endarterectomy should be applied to obtain complete revascularization in diffuse and calcified coronary disease.
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