Title : Coronary artery bypass grafting with or without coronary endarterectomy

Background: The surgical options for diffuse coronary artery disease (CAD) are still controversial especially, in patients with advanced atherosclerotic disease. Coronary endarterectomy (CE) adjuvant to coronary artery bypass graft (CABG) has a successful role in the recovery of these patients, however, postoperative and long term outcome and complications restrict its usage when compared with CABG alone. This study was designed to compare peri and postoperative outcome of patients undergoing CABG with CE and CABG alone.

Material and Methods: In this observational study retrospective data collection was done from September 2010 to 2018. A total of 200 patients who underwent CABG were included and divided into two groups: group A patients underwent CABG and group B patients underwent CABG with coronary endarterectomy. Patients were managed by a single surgeon at various public and private healthcare settings. Adult patients of both genders were studied. Patients with history of previous bypass grafting were excluded. The study outcomes were postoperative morbidity such as myocardial infarction (MI), reexploration and mortality.

Results: Age and gender of patients were comparable among both groups with male dominance. Postoperative MI, re-exploration, respiratory failure, stroke, mediastenitis were found slightly greater in the CABG with CE group. Two (2.0%) patients died in CABG group and 3 (3.0%) in CABG with CE group. Hospital stay was significantly longer in CABG with CE group (7.8 versus 7.0 days; p-value, 0.008). Similarly, the stay in intensive care was also significantly longer in CABG+ CE group (3.5 versus 2.4 days; p-value; 0.001).

Conclusion: Coronary endarterectomy may be a feasible method for adequate and complete revascularization of complex and diffuse coronary artery disease in patients undergoing CABG.

Prof. Javed Iqbal is a distinguished Cardiac Surgeon and Professor/HOD with over 20 years of experience in cardiac surgery. He holds MBBS, MCPS, FCPS (Cardiac Surgery), FACC (USA), and CHPE qualifications. He has performed more than 5,000 open and closed heart surgeries, including CABG, valve replacements, congenital heart procedures, and complex redo surgeries. Prof. Iqbal has served at leading cardiac institutions in Pakistan and Saudi Arabia and is an approved FCPS/MS supervisor and examiner. He has authored numerous research publications in cardiovascular and surgical fields and has participated in international conferences as a speaker and session chair.