Mid-term outcomes of surgical myocardial revascularization using coronary endarterectomy in diffuse coronary artery disease

Aim. To evaluate the mid-term outcomes of surgical myocardial revascularization in combination with coronary endarterectomy in patients with diffuse coronary artery disease (CAD).

Material and methods. In this cohort, non-randomized, retrospective, longitudinal study, we compared the mid-term outcomes of surgical myocardial revascularization in combination with coronary artery endarterectomy in patients with diffuse CAD with the outcomes of surgical myocardial revascularization without endarterectomy in patients without diffuse CAD. The study group included 93 patients, while the control group — 99 patients. Mid-term mortality, morbidity, and angiographic outcomes of surgical revascularization were assessed.

Results. The mean follow-up period was 46,7±18,5 months. Mid-term mortality was 5,5% (n=5) in the coronary endarterectomy group and 3,1% (n=3) in the isolated coronary artery bypass grafting (CABG) group (p=0,486). Angina recurrence was noted in 14,3% (n=13) of patients in the endarterectomy group and in 14,4% (n=14) of cases in the isolated CABG group (p=0,977). Coronary artery stenting was required in the mid-term period in 4,4% (n=4) of patients in the endarterectomy group and 4,1% (n=4) (p=1000) in the isolated CABG group. A stroke in the mid-term period occurred in 1 (1,1%) patient of the study group and 3 (3,1%) patients in the control group (p=0,334). Graft patency in the anterior interventricular artery was 90,9%, while in the circumflex artery — 100% and in the right coronary artery — 80,4%. There were no significant differences in the patency level between the study and control groups. Quality of life did not differ significantly between groups in the mid-term period.

Conclusion. Coronary endarterectomy is not associated with an increase in mortality and morbidity in the mid-term period, and is accompanied by satisfactory angiographic patency rates. There was no negative effect of coronary endarterectomy on the quality of life in the mid-term period.

1. Kurbanov SK, Vlasova EE, Vasiliev VP, et al. Prediction of clinical course in patients with diffuse coronary artery disease after coronary bypass surgery. Russian Journal of Cardiology. 2022;27(1):4727. (In Russ.) doi:10.15829/1560-4071-2022-4727.

2. Tarasov RS, Kazantsev AN, Barbarash LS, et al. The results of an aimed incomplete myocardial revascularization with low invasive and standard technics of coronary bypass. Russian Journal of Cardiology. 2018;(7):47-52. (In Russ.) doi:10.15829/1560-4071-2018-7-47-52.

3. Wang J, Gu C, Yu W, et al. Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting: A Meta-Analysis of 63,730 Patients (PRISMA). Medicine (Baltimore). 2015;94(41):e1781. doi:10.1097/MD.0000000000001781.

4. Wang C, Chen J, Gu C, et al. Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2019;29(3):393-401. doi:10.1093/icvts/ivz125.

5. Wang C, Chen J, Gu C, et al. Impact of risk factors and surgical techniques in coronary endarterectomy: a network meta-analysis. Interact Cardiovasc Thorac Surg. 2019;29(3):355-64. doi:10.1093/icvts/ivz090.

6. Stavrou A, Gkiousias V, Kyprianou K, et al. Coronary endarterectomy: The current state of knowledge. Atherosclerosis. 2016;249:88-98. doi:10.1016/j.atherosclerosis.2016.03.036.

7. Belash SA, Barbukhatti KO, Shevchenko SS, et al. Selection of optimal endarterectomy technique in the left anterior descending artery for diffuse coronary atherosclerosis. Russian Journal of Cardiology. 2021;26(8):4397. (In Russ.) doi:10.15829/1560-4071-2021-4397.

8. Visker YYu, Kovalchuk DN, Molchanov AN, et al. Coronary endarterectomy in myocardial revascularization. Russian Journal of Cardiology. 2021;26(8):4310. (In Russ.) doi:10.15829/1560-4071-2021-4310.

9. Ariyaratnam P, Javangula K, Papaspyros S, et al. Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease. Eur J Cardiothorac Surg. 2012;42(6):e140-5. doi:10.1093/ejcts/ezs510.

10. Song Y, Xu F, Du J, et al. Coronary endarterectomy with coronary artery bypass graft decreases graft patency compared with isolated coronary artery bypass graft: a metaanalysis. Interact Cardiovasc Thorac Surg. 2017;25(1):30-6. doi:10.1093/icvts/ivx045.

11. Soylu E, Harling L, Ashrafian H, et al. Does coronary endarterectomy technique affect surgical outcome when combined with coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2014;19(5):848-55. doi:10.1093/icvts/ivu261.

12. Ghatanatti R, Teli A. Coronary Endarterectomy: Recent Trends. J Clin Diagn Res. 2017;11(8):PE01-PE04. doi:10.7860/JCDR/2017/27036.10339.

13. Soylu E, Harling L, Ashrafian H, et al. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a metaanalysis. Interact Cardiovasc Thorac Surg. 2014;19(3):462-73. doi:10.1093/icvts/ivu157.

14. Belash SA, Barbukhatti KO, Porkhanov VA. Comparative analysis of early results of reconstructive procedures on coronary arteries with and without endarterectomy in diffuse coronary atherosclerosis. Russian Journal of Thoracic and Cardiovascular Surgery. 2019;61(1):45-54. (In Russ.) doi:10.24022/0236-2791-2019-61-1-45-54.

15. Takousi MG, Schmeer S, Manaras I, et al. Health-Related Quality of Life after Coronary Revascularization: A systematic review with meta-analysis. Hellenic J Cardiol. 2016:S1109- 9666(16)30145-2. doi:10.1016/j.hjc.2016.05.003.