Long-Term Outcomes of Coronary Endarterectomy in Patients With Complete Imaging Follow-Up

Coronary endarterectomy (CEA) within coronary artery bypass grafting (CABG) is controversially discussed; however, CEA is considered as a last option for severely diseased coronary arteries. We therefore aimed to evaluate outcomes of patients undergoing CABG with CEA. We present a retrospective single surgeon's experience. Between 05/1999 and 12/2017, 426 patients underwent CABG with CEA. Follow-up imaging was proposed to all surviving patients, and only patients accepting were considered for this study. This resulted in a cohort of 112 patients within a mean postoperative interval of 53 ± 49 months. Study endpoints are graft patency, overall survival, and incidence of major-adverse-events. Mean patients’ age was 65.5 ± 9.4 years; 90.2% were male. A total of 139 CEAs were performed (24 patients had more than 1 CEA-graft). Most of patients (91.1%) presented with 3-vessel disease. Mean syntax score was 29.8 ± 8.5. Four ± 1.3 grafts were constructed per patient; CEA target coronaries were either totally (31.9%) or subtotally (68.1%) occluded. CEA was performed at LAD- or RCA-territory (42.4% each) or LCX-territory (15.1%). Early postoperative outcomes reported stroke in 2 patients, myocardial infarction in 4 patients with 2 patients dying. Imaging follow-up reported 119 (out of 139) patent vs 20 occluded CEA-grafts (17 venous and 3 arterial). Long-term survival was 77.7% and freedom from major-adverse-events was 63.3% within mean follow-up time of 83 ± 67 months. Although CEA is a complex and second-line procedure, it offers a surgical option to allow myocardial revascularization in patients with diffuse or severe coronary artery disease. Good short- and long-term results can be achieved. © 2019 The Authors