Early Results of Coronary Artery Bypass Grafting Surgery with or without Coronary Endarterectomy

Ahmed   Emara; Moataz  Rizk; Ahmed Amr; Ibrahim  Kasb; Yousry Shaheen

Ahmed Emara Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Moataz Rizk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed Amr Department of Cardiothoracic Surgery, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Ibrahim Kasb Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Yousry Shaheen Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Coronary artery bypass grafting, Coronary endarterectomy, Ischemic heart disease

Abstract

Background: Managing patients with diffuse coronary artery disease is challenging. The advantages of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) compared to CABG alone are controversial. This study compared short-term outcomes, including ICU and hospital stays, arrhythmias, postoperative myocardial infarction, renal impairment, and hospital mortality, between patients who underwent CABG without and with CE.

Methods: This randomized controlled study included 100 patients who underwent CABG with or without CE. Participants were randomly allocated into two equal groups. Group I (n=50) included patients who underwent CABG alone, and Group II (n=50) included patients who underwent CABG combined with CE.

Results: The right coronary artery was the most common vessel affected by CE (44%), followed by the left anterior descending artery (42%). Low-output syndrome and pleural effusion were more frequently observed in Group II; however, these differences did not reach statistical significance. There was no difference in postoperative complications or ejection fraction between the groups. The ICU stay was significantly longer in Group II (3.02±0.84 vs. 2.58±0.5 days; p=0.007). Additionally, patients in Group II had significantly longer hospital stays (14.48±1.87 vs. 11.98±1.35, p<0.001).

Conclusion: Compared with CABG alone, CABG with CE might not be associated with increased short-term mortality or morbidity. CABG with CE was associated with prolonged hospitalization, necessitating a careful assessment of the benefits versus an extended hospital stay when considering this adjunctive procedure.