The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting

Amac: Bu calismada, koroner endarterektominin (KE) eszamanli koroner arter baypas greftleme (KABG) geciren hastalarda morbidite ve mortalite uzerindeki etkisi arastirildi. Ca­lis­ma­ pla­ni:­ Mart 2000 ve Nisan 2010 tarihleri arasinda KABG cerrahisi ile beraber eszamanli KE ve yama plasti geciren 587 hasta (KABG+KE grup) retrospektif olarak inceledi. Hastalar randomize bir sekilde secilmis ve ayni donemde KE olmadan KABG cerrahisi gecirmis 600 hasta (KABG grup) ile karsilastirildi. Hasta dosyalarindan edinilen buyuk parametre serileri ve alt grup analizi ile gruplarin kapsamli bir degerlendirmesi yapildi. Bul gu lar: KABG+KE grubundaki hastalar, KABG grubundakilerden daha yasliydi (59.6±10.3’e kiyasla 61.3±7.3; p<0.001). Aterosklerotik risk faktorleri insidansi, uc damar hastaligi ve kararsiz angina pektoris sikayetleri KABG+KE grubunda biraz daha yuksekti (p<0.05). Eszamanli KE, kros klemp ve kardiyopulmoner baypas suresini uzatti. Ayrica, ameliyat sonrasi toplam entubasyon suresi (12±10.3’e kiyasla 12±7.4 saat; p<0.05) anlamli sekilde daha uzundu (p<0.05). Miyokard enfarktusu (p=0.006) ve intraaortik balon pompasi gerekliligi (p<0.001) oranlari KABG+KE grubunda anlamli olarak daha yuksekti. Mortalite orani iki grup arasinda farkli degildi. So­nuc:­ Endarterektomi endikasyonu sinirlayici bir sekilde ele alinmaya devam edilmelidir. Endarterektomi, anastomozun teknik olarak mumkun gorunmedigi, sadece tikanmis, yari tikanmis veya ciddi bir sekilde kalsifiye olmus damarlarda uzun sureli stenoz ile uygulanmalidir. Endarterektomi, KABG’nin yerine kullanilmamali ve deneyimli bir cerrahi ekibi tarafindan uygulanmalidir. Ote yandan, konvansiyonel koroner baypas cerrahisine kiyasla KE ek mortalite ile iliskilendirilemeyebilir. Anah tar soz cuk ler: Koroner damarlar; endarterektomi; takip calismalari; morbidite; mortalite. Background:­This study aims to investigate the effect of coronary endarterectomy (CE) on morbidity and mortality in patients undergoing concomitant coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed 587 patients who underwent CABG surgery with concomitant CE (CABG+CE group) and patch plasty between March 2000 and April 2010. We compared these patients with randomly selected 600 patients who had undergone CABG surgery without CE (CABG only group) in the same period. A comprehensive evaluation of the groups was achieved by subgroup analysis with large series of parameters from patient files. Results:­The patients in the CABG+CE group were older than the patients in the CABG only group (59.6±10.3 vs. 61.3±7.3; p<0.001). The incidence of atherosclerotic risk factors, triplevessel disease, and complaints of unstable angina pectoris were slightly higher in CABG+CE group (p<0.05). Concomitant CE prolonged cross-clamp and cardiopulmonary bypass time. Also, postoperative total entubation time (12±10.3 vs. 12±7.4 hours; p<0.05) was significantly longer (p<0.05). The rates of myocardial infarction (p=0.006) and intra-aortic balloon pump requirement (p<0.001) were significantly higher in the CABG+CE group. The mortality rate did not differ between the two groups. Conclusion:­ Indication for CE must still be handled restrictively. Endarterectomy should be performed only on occluded, nearly occluded, and/or severely calcified vessels with long-range stenosis if regular anastomoses to these vessels seem to be technically impossible. Endarterectomy should not be considered as a substitute for CABG, and should be performed by an experienced surgical team. However, CE might not be associated with additional mortality compared to conventional coronary bypass surgery.