Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease

OBJECTIVES: The role of coronary endarterectomy (CE) in modern cardiac surgery has been an extant debate as coronary arterybypass grafting (CABG) has advanced. However, as cardiac surgeons are being referred ever more complex coronary disease for surgicalcorrection, adjunctive strategies may need re-evaluation. The long-term results of CE are largely unknown. We present the longestcohort follow-up in a single institution looking at our 20-year experience of CEs employed as an adjunct to CABG in diffuse coronaryartery disease.METHODS: We performed retrospective analysis of data collected prospectively on 801 patients undergoing CEs between February1988 and September 2010 by a single surgeon using a standard open hydrodissection technique. We looked at patient demographics,characteristics of the vessels subjected to endarterectomy and predictors of long-term survival within this surgical group using Cox’sregression analysis.RESULTS: The mean age was 63.2 (±9.6) years. The mean number of coronary arteries undergoing endarterectomy was 1.16 (±0.4) perpatient. Of these, 63.7% were performed on the right coronary artery (n = 558) and 32.3% on the left anterior descending artery(n = 283). The operative mortality was 2.62% (n = 21). The median survival time was 16.67 years (95% confidence interval 15.14–18.19years). The significant predictors of survival (P <0.05) were a lower age at surgery, a lower EuroSCORE I, the absence of peripheralvascular disease and shorter bypass times.CONCLUSION: This significant long-term survival demonstrates that CE can be an attractive adjunct to CABG in otherwise inoperablecoronary artery disease.Keywords: Coronary artery bypass grafting surgery • Endarterectomy