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Ravindranath Tiruvoipati
Mahmoud Loubani
Shilajit Ghosh
Ramesh L. Patel
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Ann Thorac Surg 2005;79:1999-2003
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Coronary Endarterectomy: Impact on Morbidity and Mortality When Combined With Coronary Artery Bypass Surgery

Ravindranath Tiruvoipati, FRCSa,*, Mahmoud Loubani, MD, FRCSIa, Mauro Lencioni, MRCPb, Shilajit Ghosh, FRCS(CTh)a, Peter W. Jones, PhDc, Ramesh L. Patel, MD, FRCS(CTh)a

a Department of Cardiothoracic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry
b Department of Cardiology, University Hospitals of Coventry and Warwickshire NHS Trust, Walsgrave Hospital, Coventry
c Department of Statistics, School of Computing and Mathematics, Keele University, Keele, United Kingdom

Accepted for publication December 28, 2004.

* Address reprint requests to Dr Tiruvoipati, Dept of ECMO, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, United Kingdom (E-mail: travindranath{at}hotmail.com).

BACKGROUND: The results of coronary endarterectomy (CE) performed in addition to coronary artery bypass grafting (CABG) have been controversial. We aimed to examine the impact of CE performed in addition to CABG when compared with CABG alone in our unit.

METHODS: Patients who had CABG between January 1995 and December 2001 were included. They were divided into two groups, the CABG-only group and CABG and CE group. The following outcomes were compared: perioperative myocardial infarction, postoperative ventricular arrhythmias, cerebrovascular accident, renal impairment, and early mortality.

RESULTS: Of 5,782 patients who underwent CABG, 461 patients (8.6%) required CE in addition to CABG. There was a higher mortality and incidence of postoperative renal impairment in the group of patients who had CABG and CE, with no significant difference in other outcomes. However, the patients in the CABG and CE group had a higher incidence of male sex, previous myocardial infarctions, preoperative renal impairment, and poor left ventricular function, with longer cross-clamp and cardiopulmonary bypass times than in the CABG-only patients. Although female sex, renal impairment, nonelective surgery, impaired left ventricular function, and peripheral vascular disease were associated with increased mortality in all the patients, and use of statins and aspirin was associated with a reduction in mortality, CE was not a predictor of mortality. Furthermore, on propensity scores analysis, CE was not associated with increased mortality.

CONCLUSIONS: Coronary endarterectomy when combined with CABG seemed to be associated with a higher mortality than isolated CABG in our study groups, but this is related to comorbidities of these patients rather than the CE.






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