Coronary endarterectomy as an adjunct to coronary artery bypass grafting: Real-world outcomes from a decade-long experience.

Objectives: To compare the short- and long-term outcomes of coronary endarterectomy (CE) as an adjunct to coronary artery bypass grafting (CABG) with CABG alone in patients with diffuse coronary artery disease (CAD). Methods: Postoperative complications, in-hospital and long-term mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) were compared between 702 patients undergoing CE + CABG and 2808 propensity score-matched patients undergoing CABG alone at Tehran Heart Center between 2007 and 2016 and during a median follow-up of 98.6 months (96% confidence interval [CI], 97-99.9 months). Results: Preoperative risk factors were perfectly balanced between the 2 groups. Compared to the CABG-only group, patients in the CE + CABG group had longer median aortic cross-clamp time (53.5 [interquartile range (IQR), 43-66.3] minutes versus 45 [IQR, 35-55] minutes; P < .001), longer cardiopulmonary bypass time (90 [IQR, 71-110] minutes vs 75 [IQR, 60-93] minutes; P < .001), longer intensive care unit stays (44.3 [IQR, 23.5-71] hours vs 25.3 [IQR, 22-48] hours; P < .001), longer duration of mechanical ventilation (10 [IQR, 8-13] hours vs 9.3 [IQR, 7-12] hours; P = .001), and higher rates of transfusion (46.9% vs 39.4%; P < .001) and in-hospital mortality (2.1% vs 0.8%; P = .003). Among short-term complications, pericardial involvement was more common in the CE + CABG group, but there were no significant differences in rates of cerebrovascular events, cardiac arrest, and infective complications. Despite comparable long-term mortality (hazard ratio [HR], 1.10; 95% CI, 0.93-1.31), patients undergoing CE + CABG had slightly higher rates of MACCE in their long-term follow-up (HR, 1.16; 95% CI, 1.01-1.33). Conclusions: Despite higher rates of short-term morbidity and mortality, CE + CABG, if performed after meticulous patient selection and by experienced surgeons, could be an acceptable approach with favorable long-term outcomes in patients with diffuse CAD.