Abstract 4173: The Impact of Coronary Artery Endarterectomy on Outcomes During Coronary Artery Bypass Grafting
Background: The safety of coronary artery endarterectomy (CE) during coronary artery bypass grafting has been debated. We examined the outcome of CE compared to isolated coronary artery bypass grafting (CABG) at our institution.
Methods: Patients undergoing CABG are prospectively entered into our database. Of 1884 patients from 2003–2008 who underwent isolated CABG, we identified 99 patients who underwent CE. A 3:1 propensity match, using STS predicted risk of mortality, age, gender, year of surgery, and ejection fraction, was used to select 297 control patients who underwent isolated CABG. Risk factors and outcomes were compared between the two groups.
Results: Preoperative risk factors were not different between patients undergoing CE or CABG. Cross clamp times (95.6 vs. 71.8 min, p=0.0001), and perfusion times (121.8 vs. 92.7 min, p=0.0001) were longer in patients undergoing CE. Operative mortality (4.0%-4/99 vs. 1.3%-4/297, p=0.112) and complications including renal failure, stroke, and MI were no different between groups. Post-operative pneumonia (9.1 %-9/99 vs. 1.3%-4/297, p=0.001) and prolonged ventilation (16.2 %-16/99 vs. 8.1%-24/297, p=0.032) were more common in patients undergoing CE. Resource utilization including ICU length of stay (75.06 vs. 48.64 hrs, p=0.001), and hospital length of stay (9.01 vs. 7.7 days, p=0.034) were also longer in patients undergoing coronary endarterectomy.
Conclusion: Patients undergoing CABG with coronary endarterectomy required longer ventilatory support and ICU stay, most likely due to the added complexity of CE. However, operative mortality and major complications were comparable with CABG, making endarterectomy a safe option for patients with diffuse disease.