Outcomes of Patients Undergoing Closed Traction CoronaryEndarterectomy: A Long-Term Single Center Study.

Abstract

Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% (n = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally (n = 111, 28.2%) or sub-totally (n = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.