Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques

Abstract

Background: Coronary endarterectomy (CE) may be a good option for complete revascularization of diffuse coronary artery diseases, but it has not been widely used because the outcomes have not been definitively identified. This study aims to evaluate the mid-term clinical results of CE and compare the outcomes according to the use of cardiopulmonary bypass (CPB) and the surgical technique used. Methods: Between 2004 and 2014, 69 cases of CE were performed in 64 patients. We divided the patients into two groups: 1) on-pump coronary artery bypass with coronary endarterectomy (ONCAB-CE) versus off-pump coronary artery bypass with coronary endarterectomy (OPCAB-CE), and 2) “open” versus “closed” surgical techniques. Operative mortality and major morbidity, were investigated including perioperative myocardial infarction (PMI), and overall survival. Results: Operative mortality was 4.7% (3/64), and no PMI was observed in the study. No statistical differences in operative mortality rate between the ONCAB-CE and OPCAB-CE groups were found (3.1% vs. 6.2%, p = 1.0) or between open versus closed techniques (6.7% vs. 2.9%, p = 0.6). The incidence of major morbidity including cerebrovascular accident, atrial fibrillation, acute renal failure, mediastinitis, respiratory complications, and bleeding was comparable between all groups. There were seven late mortalities, and no differences were found in overall survival rate between all groups. Conclusions: Coronary endarterectomy appears to be a safe option for patients with diffuse coronary artery disease, regardless of whether CPB or a specified selection of surgical techniques are used.