Outcomes of Coronary Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting for Coronary Artery Disease – a Retrospective Study

Abstract

Abstract Complete revascularization of coronary arteries, and mainly of the left anterior descending artery (LAD) which plays a significant role in terms of postoperative outcomes, is the primary objective in coronary artery bypass grafting (CABG). Nowadays, more and more patients having stenoses in one or two coronary vessels tend to be treated by percutaneous coronary intervention (PCI) [1]. As a result, diffuse coronary artery disease (CAD) is more likely among patients referred for CABG [2,3]. However, up to 25% of patients with diffuse CAD cannot be safely and successfully treated by standard CABG [4]. Therefore, several techniques including coronary endarterectomy, which involves the removal of the atherosclerotic core from the coronary artery lumen through an arteriotomy [5], have been proposed to expand surgical possibilities. Baily et al. [6] were the first to describe coronary endarterectomy as a treatment against CAD without using CABG in 1957. However, its accompanying morbidity and mortality over shadowed its success in angina relief 7. In particular, endarterectomy of the LAD was considered technically difficult8 and it initially appeared to be accompanied by high operative mortality and perioperative myocardial infarction9. Hence, coronary endarterectomy indications were restricted to those patients with diffuse Coronary artery disease . Since that time, several publications have shown that coronary endarterectomy either with on-pump CABG 10 or with off-pump CABG can be safely performed 11 and is associated with favourable long-term outcomes 11 Primary objective : 1. To Study ten year Survival for patients undergoing coronary endarterectomy in patients with coronary artery disease Secondary Objective: 2. To determine any major adverse cardiac and cerebrovascular events in patients undergoing coronary endarterectomy with coronary artery by pass graft. Results: Total of 62 patients underwent coronary artery bypass grafting with coronary endarterectomy.62patients fulfilled inclusion our study and were followed up. Out of 62, More then half of patients had four number of grafts (51.6%),followed by five grafts (27.4)% and three grafts in 16.1 % of patients. and six graft in 3.2 % of patients. Out of total patients 32(51.6%) patients had 3 venous grafts followed by 17(27.4%) patients had 4 number of venous graft and 10(16.1%) patient had 2 venous graft and one patients (1% ) with one venous graft in our study . In our study ,we used LIMA to anastomosed with LAD in sixty number of patients which constitutes 96.8 %, 11 patients had only right coronary artery bypass grafting with 1.6 % of patients.,LAD+RCA+PDA was bypassed in 60 patients constituting total of 96.8%.Additionally LAD+RCA was territory was grafted in one patient. Out of 62 patients , LAD was endarterectorised in 15 patients and 24.2% and endarterectomy for PDA artery was done in 7 p0atients (11.3),followed by OM2 – four patients (6.5%), OM -1 in 2 patients (3.2%) ,OM-3-1 patients (1.6%) and lastly distal RCA in 1 patients (1.6%). Total mortality till date was 5 (8.06%)and 1 in hospital mortality due to multi-organ dysfunction syndrome out of total 62 patients. Conclusion: In the recent decades, the treatment of older patients with diffuse CAD, alongside multiple comorbidities and high expectations for successful treatment, has become a real challenge. CE is a surgical method that can provide acceptably effective and safe results in the treatment of CAD. CE as an adjunct to CABG, has a significant role in achieving adequate revascularisation and in improvement of long term outcomes. The survival rate of 98.4% at 1 year and 96.5% at 5 years and 81.4% at 10 year