Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries

Abstract Objective: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. Methods: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. Results: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. Conclusion: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

摘要 研究目的：对比两组患者——冠状动脉内膜切除术（Coronary Endarterectomy, CE）组（接受冠状动脉旁路移植术（Coronary Artery Bypass Grafting, CABG）联合CE的患者）与对照组（接受单纯CABG的患者）。本研究分析了两组的主要不良结局发生率（围术期急性心肌梗死（Acute Myocardial Infarction, AMI）、脑卒中及死亡率）与次要结局指标（体外循环（Cardiopulmonary Bypass, CPB）时长、主动脉阻断时长及术后住院时长），同时明确了接受CE治疗患者的早期移植血管通畅率。

研究方法：回顾性分析2011年1月至2017年6月期间接受CABG（伴或不伴联合CE）的患者数据库。将25例接受CE的患者与201例仅接受常规CABG的患者进行对照，两组术前基线特征匹配，欧洲心脏手术风险评估系统Ⅱ（European System for Cardiac Operative Risk Evaluation Ⅱ, EuroSCORE Ⅱ）的所有变量均无统计学差异。本研究设定P<0.05为具有统计学显著性的判定标准。

研究结果：两组在术后住院时长（P=0.8139）、围术期AMI发生率（P=0.2976）、脑卒中发生率（P=0.2976）及死亡率（P=1.0000）方面均无统计学差异；但CE组的主动脉阻断时长（P=0.0004）与CPB时长（P=0.0030）显著更长。接受CE治疗患者的移植血管通畅率为78.95%，与文献报道结果相符。

研究结论：在本研究队列中，冠状动脉内膜切除术的早期移植血管通畅率与文献报道一致，其围术期发病率与死亡率与常规CABG手术无显著差异。