title: Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  This significant long-term survival demonstrates that CE can be an attractive adjunct to CABG in otherwise inoperable coronary artery disease.
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK. priyadariyaratnam@yahoo.co.uk
authors.forename: Priyadharshanan
authors.initials: P
authors.lastname: Ariyaratnam
authors.forename: Kalyana
authors.initials: K
authors.lastname: Javangula
authors.forename: Sotiris
authors.initials: S
authors.lastname: Papaspyros
authors.forename: Evie
authors.initials: E
authors.lastname: McCrum-Gardner
authors.forename: Ramanpillai Unnikrishanan
authors.initials: RU
authors.lastname: Nair
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome