Clinical Outcomes of Adjunctive Coronary Endarterectomy in Patients with Diffuse Coronary Artery Disease: A Pilot Study

Abstract

Background: Cardiovascular diseases (CVDs), particularly coronary artery disease (CAD), remain a leading cause of global mortality. While coronary artery bypass grafting (CABG) is a standard treatment, patients with diffuse CAD often require adjunctive techniques to achieve complete revascularization. Objectives: Coronary endarterectomy (CE) has emerged as a valuable adjunct to CABG, aiming to improve blood flow in severely diseased arteries. This study aimed to evaluate the clinical outcomes, changes in blood biomarkers, and postoperative complications in patients undergoing adjunctive CE with CABG. Methods: This retrospective cohort study included 50 patients who underwent CE with CABG between 2012 and 2021. We extracted data on demographics, comorbidities, pre- and postoperative biomarkers, ejection fraction (EF), length of ICU stay, number of grafts, endarterectomized vessel, and postoperative outcomes from medical records. Data were analyzed using descriptive statistics, chi-square tests, independent samples t-tests, and Mann-Whitney U tests. Statistical significance was set at P < 0.05. Results: The mean ± SD age of patients was 63.96 ± 9.35 years, with 66% being male. Hypertension (HTN) was the most prevalent comorbidity (66%). The mean ± SD hospital stay was 147.12 ± 51.51 hours. A significant decrease in mean EF was observed postoperatively (48% ± 8.77 to 44% ± 9.28, P = 0.002). Postoperatively, significant increases were noted in white blood cell (WBC) counts, blood urea nitrogen (BUN), creatinine, prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR; all P < 0.001, except creatinine P = 0.002), while hemoglobin (Hb) levels significantly decreased (P < 0.001). The majority of patients (46%) received four grafts, and the left anterior descending (LAD) artery was the most common site for endarterectomy (44%). The in-hospital mortality rate was 2%. Acute kidney injury (AKI) was the most frequent complication (38%), followed by dyspnea (28%) and pulmonary edema (20%). Conclusions: Adjunctive CE was associated with a low in-hospital mortality rate and an acceptable complication profile, representing a viable surgical strategy for patients with diffuse CAD, particularly when complete revascularization is challenging. Further large-scale, multi-center prospective studies with long-term follow-up are warranted to validate these findings and explore the influence of specific patient characteristics on long-term outcomes.