Long term survival after coronary endarterectomy in patients undergoing combined coronary and valvular surgery – a fifteen year experience

Between 1989 and 2003, 237 patients underwent CABG with valve surgery under a single surgeon at our institution. Of these, 41 patients needed CE. Data was retrospectively obtained from hospital records and database. Further follow-up was obtained by telephone interview. All variables were analyzed by univariate analysis for significant factors relating to hospital mortality. Morbidity and long term survival was also studied. There were 29 males and 12 females with a mean age of 67.4 ± 8.1 and body mass index of 26.3 ± 3.3. Their mean euroscore was 7.6 ± 3.2 and the log euro score was 12.2 ± 16.1.Thirty-two patients were discharged from the intensive therapy unit within 48 hours after surgery. Average hospital stay was 12.7 ± 10.43 days. Thirty day mortality was 9.8%. Six late deaths occurred during the 14 year follow up. Ten year survival was 57.2% (95% CL 37.8%–86.6%). Three of the survivors had Class II symptoms, with one requiring nitrates. None required further percutaneous or surgical intervention. We compared the result with the available mortality figure from the SCTS database.Compared to the SCTS database for these patients, we have observed that CE does not increase the mortality in combined procedures. By accomplishing revascularization in areas deemed ungraftable, we have shown an added survival benefit in this group of patients.Coronary endarterectomy (CE), first described by Bailey et al in 1957, has been shown to benefit patients with advanced coronary atheroma by providing complete revascularization. [1] The safety and long-term efficacy of the procedure, although controversial, has been demonstrated in earlier studies. [2,3]There have been no studies on the effect of endarterectomy in patients undergoing valve surgery with concomitant coronary bypass. This study was aimed at auditing the mortality and morbidity of patients undergoing combined valvular and coronary artery surgery with additional CE. We also looked at the symptomatic relief and long-te