M. Usman1, H. Mallick1, N. Sabahat1, Z. Kamran1, S. Shahabuddin1 1Aga Khan University Medical College, Cardiothoracic, Karachi, Sindh, Pakistan
Introduction: Coronary Artery Bypass Grafting (CABG) remains a cornerstone in treating coronary artery disease. When total revascularization is unviable due to severe atherosclerosis, Coronary Endarterectomy (CE) supplements CABG. This study aims to scrutinize early CE outcomes within 30 days, assess preoperative risk factors, and analyze peri-operative complications
Methods: A retrospective analysis was conducted from January 1995 to December 2021. Data encompassed demographics, pre-operative characteristics, operative details, and post-operative outcomes, collected through chart reviews. The study focused on early outcomes, including 30-day mortality, morbidity, and length of stay, while evaluating both preoperative and postoperative factors. The retrospective design facilitated long-term trend analysis.
Results: The study comprised 80 patients with a mean age of 58±9.35, 90% of whom were male. Mean BMI was 27.4±6.01, and mean EF% stood at 48.5±15. Median bypass time was 125 min, with a median cross-clamp time of 87 min. Notably, 70% had hypertension, 67.5% had diabetes, 8.8% exhibited peripheral vascular disease, and 1.3% were dialysis-dependent. Cerebrovascular disease was present in 5%, and 2.5% had congestive heart failure (CHF). Endarterectomy was performed predominantly on the LAD vessel (51%) and RCA/PDA (41%). LMD >50% was observed in 26.3%. Of the patients, 91% had 3-vessel coronary artery disease, 22.5% experienced MI within <7 days, and 36.3% beyond 7 days.
Complications included a 5% re-open rate for any reason, deep sternal wound infection in 1.3% of patients, leg wound complications in 1.3%, pneumonia in 3.8%, and prolonged ventilation in 12.5%. Furthermore, 17% required CICU stays exceeding 48 hours, and 53.8% received blood or blood products. The median length of stay was 6.0 days. The operative mortality rate was reported at 2.5%, and no strokes were observed.
Conclusion: In isolated CABG, concurrent CE demonstrates promising early outcomes within 30 days, particularly when comprehensive revascularization options are limited. The study highlights the feasibility and safety of this approach. However, further research is indispensable to comprehend the long-term implications of CE in CABG patients.