A Retrospective Cohort Study on Coronary Endarterectomy Outcomes in Coronary Artery Bypass Graft Patients at a Tertiary Care Hospital in Peshawar, Pakistan

INTRODUCTION: The aim of this study is to determine the outcomes following coronary endarterectomy (CE) in patients who underwent coronary artery bypass grafting (CABG) for revascularization in our hospital. METHODS: We retrospectively reviewed patients who underwent CABG over a six-month period, from November 1, 2016 to May 31, 2017 and examined their outcomes in regards to CE. RESULTS: A total of (n=361) CABG procedures were performed in our study period, though complete records were available for only (n=254) patients. Amongst these, (n=37) patients (14.5%) required CE. Ages ranged from 43 to 75 years for these patients, (n=7) were females and (n=30) males. Comorbidities included hypertension in (n=19) patients, diabetes in (n=12) patients and hepatitis B in (n=11) patients. The right coronary artery (RCA) was the most common artery endarterectomized (n= 15), followed by the left anterior descending (LAD) (n= 10), obtuse marginal (n= 6 patients), diagonals (n=5) and ramus (n=2). Two vessels were endarterectomized in (n=4) patients. A total of (n=9) patients had two-vessel CABG, (n=16) had three-vessel CABG and (n=8) had four-vessel CABG. The left internal mammary artery (LIMA) was used in (n=25) patients. Two patients required intra-aortic balloon pump post-operatively. All the patients had received inotropic support postoperatively in the intensive care unit (ICU). There were no reports of postoperative mortality. One patient remained in the ICU for four days postoperatively, the rest of the patients were stepped down to the ward in less than four days. CONCLUSIONS: CE is a safe and viable option as an adjunct to CABG in long segment totally occluded vessels needing revascularization and reconstruction.