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Coronary Endarterectomy in Patients Undergoing Off Pump Coronary Artery Bypass Grafting: Surgical Experience in a Rural Tertiary Care Cardiac Centre

Shaffeek A. Department of Cardiovascular and Thoracic surgery Government Medical College, Thiruvananthapuram, Kerala 695011, India. , Ravikrishnan J.* , Shaffeek A.*

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Journal of Cardiovascular Medicine and Surgery 3(2):p 146-152, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.11

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Abstract

Background: Coronary artery bypass grafting (CABG) is the most frequently performed cardiac surgical procedures. The category of patients undergoing CABG has gradually reduced to more high risk group, requiring additional procedures like coronary endarterectomy. This study is to prove that off pump coronary endarterectomy can be performed safely with comparable morbidity and mortality as in conventional coronary endarterectomy. Material and Methods: 120 patients who underwent concomitant off pump coronary artery bypass grafting and coronary endarterectomy, over a period of 2 years, were included in this study. Average number of coronary bypass grafts were 2.2 ± 0.63. 80(66.8%) had left anterior descending artery (LAD), 56(46.2%) had right coronary artery and 9(7.9%) had obtuse marginal artery endarterectomies, with 62 receiving left internal mammary artery as the arterial graft to LAD. 3(2.5%) patients were converted to on pump surgery intraoperatively due to hypotension. The total surgery time, hospital stay, postoperative left ventricular ejection fraction (LVEF %), postoperative myocardial infarction (ECG changes), and drainage data was collected and compared with that of conventional surgery. All statistical analysis was done using SPSS software. Continuous variables were reported as mean±S.D. Continuous variables were compared by Chisquare test or Fischer’s exact test. Differences were considered significant at p < 0.05. Results: The mean operating time was 118 ± 22minutes, postoperative drainage was 220±85 ml, and hospital stay was 5±1.3 days. Preoperative and postoperative LVEF was 46.13±4.4 and 54.37±1.6 respectively. 1 patient (0.83%) had postoperative MI. Had 1(0.83%) mortalityat 1 month due to bowel ischemia and septicaemia. Conclusion: We conclude that off pump coronary endarterectomyhas comparable early and late outcomes with reference to conventional endarterectomy, even for high risk patients with diffuse coronary artery disease.

 

 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.11

Keywords

Coronary Endarterectomy; Off Pump Coronary Artery Bypass Grafting.

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