Abstract 2297: Coronary Artery Endarterectomy is Associated with Increased Early Mortality and Morbidity Irrespective of Coronary Territory Revascularized or Use of Patch Arterioplasty
INTRODUCTION: Coronary artery endartectomy (CE) has been used to reconstruct non-bypassable vessels supplying viable myocardium. It is associated with increased mortality and morbidity. We hypothesized that coronary territory selection and concomitant patch arterioplasty may improve clinical outcomes.
METHODS: Multivariable regression was performed on all isolated CABG cases from a prospective database (1990 –2007).
RESULTS: At least one CE was performed in 346 (4%) of all 9535 isolated CABG cases (right coronary artery 69%, left coronary artery 28%, both 3%). Concomitant patch arterioplasty was performed in 10%, in similar proportion to the left and right territories. Patient and operative factors were similar in the CE versus non-CE groups, except the former had longer operative times (cross-clamp time 88+27 vs 78+29 minutes; pump time 109+31 vs 97+33 minutes; both p<0.001). More distal anastomoses were performed in the CE cohort (3.4+0.9 vs 3.0+0.9, p<0.001). The CE cohort had higher 30-day mortality (4.3% vs 2.0%, p=0.003), MI (7.5% vs 2.5%, p=0.01), low output syndrome (16% vs 11%, p=0.01) and renal failure (3% vs 1%, p=0.03). Multivariable regression analysis showed CE be a significant independent predictor of early death (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6 – 4.9, p<0.001), along with age, gender, pump time, and pre-operative renal or LV dysfunction. CE was also an independent predictor of MI (OR 3.1, 95% CI 1.7–5.7, p=0.004) along with gender and pump time. Coronary territory endarterectomized or the use of patch arterioplasty was not a significant predictor of death or MI.
CONCLUSION: CE is a significant predictor of increased early death and MI following CABG. Neither target vessel selection nor the use of patch arterioplasty was found to protect against these adverse outcomes.