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

Kumar S, Agarwala S, Talbot C, Nair RU - J Cardiothorac Surg (2008)

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic surgery, Yorkshire heart Centre, Leeds General Infirmary, Leeds, UK. sanjaykr33@hotmail.com

ABSTRACT

Background: Coronary Endarterectomy (CE) in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. There are no published data on its role and benefit in patients undergoing more complex operations. We present our experience with CE in patients undergoing valve surgery with concomitant CABG.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

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Related in: MedlinePlus

Kaplan-Meier Survival curve showing the estimated survival probabilities.
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Figure 2: Kaplan-Meier Survival curve showing the estimated survival probabilities.

Mentions: The long-term survival of the 41 patients was studied. During the recorded follow-up time (between 0 and 15 years), a total of 10 deaths occurred including those immediately following the operation. A Kaplan-Meier survival curve showing the estimated survival probabilities and associated 95% confidence intervals is given in figure 2. The "latest" death occurred 10 years after the operation. The estimated survival rate at 10 years (or longer as no further deaths occurred) is 57.2% with a 95% confidence interval of 37.8%–86.6%.


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

Kumar S, Agarwala S, Talbot C, Nair RU - J Cardiothorac Surg (2008)

Kaplan-Meier Survival curve showing the estimated survival probabilities.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2291048&req=5

Figure 2: Kaplan-Meier Survival curve showing the estimated survival probabilities.
Mentions: The long-term survival of the 41 patients was studied. During the recorded follow-up time (between 0 and 15 years), a total of 10 deaths occurred including those immediately following the operation. A Kaplan-Meier survival curve showing the estimated survival probabilities and associated 95% confidence intervals is given in figure 2. The "latest" death occurred 10 years after the operation. The estimated survival rate at 10 years (or longer as no further deaths occurred) is 57.2% with a 95% confidence interval of 37.8%–86.6%.

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic surgery, Yorkshire heart Centre, Leeds General Infirmary, Leeds, UK. sanjaykr33@hotmail.com

ABSTRACT

Background: Coronary Endarterectomy (CE) in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. There are no published data on its role and benefit in patients undergoing more complex operations. We present our experience with CE in patients undergoing valve surgery with concomitant CABG.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus