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Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease.
MedLine Citation:
PMID:  23014969     Owner:  NLM     Status:  Publisher    
OBJECTIVES: The role of coronary endarterectomy (CE) in modern cardiac surgery has been an extant debate as coronary artery bypass grafting (CABG) has advanced. However, as cardiac surgeons are being referred ever more complex coronary disease for surgical correction, adjunctive strategies may need re-evaluation. The long-term results of CE are largely unknown. We present the longest cohort follow-up in a single institution looking at our 20-year experience of CEs employed as an adjunct to CABG in diffuse coronary artery disease. METHODS: We performed retrospective analysis of data collected prospectively on 801 patients undergoing CEs between February 1988 and September 2010 by a single surgeon using a standard open hydrodissection technique. We looked at patient demographics, characteristics of the vessels subjected to endarterectomy and predictors of long-term survival within this surgical group using Cox's regression analysis. RESULTS: The mean age was 63.2 (±9.6) years. The mean number of coronary arteries undergoing endarterectomy was 1.16 (±0.4) per patient. Of these, 63.7% were performed on the right coronary artery (n = 558) and 32.3% on the left anterior descending artery (n = 283). The operative mortality was 2.62% (n = 21). The median survival time was 16.67 years (95% confidence interval 15.14-18.19 years). The significant predictors of survival (P < 0.05) were a lower age at surgery, a lower EuroSCORE I, the absence of peripheral vascular disease and shorter bypass times. CONCLUSION: This significant long-term survival demonstrates that CE can be an attractive adjunct to CABG in otherwise inoperable coronary artery disease.
Priyadharshanan Ariyaratnam; Kalyana Javangula; Sotiris Papaspyros; Evie McCrum-Gardner; Ramanpillai Unnikrishanan Nair
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-26
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK.
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