Coronary endarterectomy: an old tool for patients currently operated on with coronary artery bypass grafting. Long-term results, risk factor analysis

Aim: Coronary endarterectomy (CE) may provide a useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffuse coronary artery disease. Nevertheless, the incidence of complications still remains high, long-term results remain unclear, and no risk factors for late mortality have been completely described yet. Material and methods: We retrospectively reviewed 90 consecutive patients (67 +/- 8.2 years) undergoing isolated CABG in association with CE between 2006 and 2013. Mean follow-up was 75.1 +/- 36.2 months (median: 84 months) and it was 100% complete (6755/6755 patient-months). Results: Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-year survival was 83.3 +/- 4.1%, freedom from cardiac death 92.7 +/- 2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2 +/- 10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (p = 0.018) and chronic obstructive pulmonary disease (p = 0.036). Ten-year freedom from cardiac death was better after CE on the left descending coronary artery (LAD) (93.2 +/- 3.3%) in comparison to CE not on the LAD (74.6 +/- 10.2%), although this difference did not reach statistical significance (p = 0.102). Conclusions: Although the incidence of perioperative myocardial infarction continues to be not negligible, in the presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. Coronary endarterectomy on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which to focus attention due to the increased risk of late death.