Incidence, Determinants, and Early Clinical Outcomes of Coronary Endarterectomy During Coronary Artery Bypass Grafting: A Seven-Year Single-Surgeon Experience from a South Asian Tertiary Cardiac Center

Abstract

Objectives: This study aimed to determine the incidence, clinical determinants, and early outcomes of coronary endarterectomy (CE) performed during CABG in a tertiary cardiac center in South Asia. Methodology: This retrospective cohort study was conducted at the Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from June 2018 to August 2025. Adult patients undergoing isolated CABG were included and stratified into two groups: those undergoing CABG with concomitant CE and those undergoing CABG alone. The primary outcome was in-hospital mortality (defined as death during index hospitalization or within 30 days). Secondary outcomes included postoperative complications, duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital length of stay. Results: Among 950 patients undergoing isolated CABG, 64 (6.7%) required concomitant CE. CE was performed predominantly in on-pump procedures and was associated with significantly longer cardiopulmonary bypass (CPB) duration (p = 0.017). Overall, in-hospital mortality was 1.9%, with no significant difference between CE and non-CE groups (1.6% vs. 1.9%, p > 0.05). However, CE was associated with a higher incidence of postoperative complications (32.8% vs. 15.6%, p = 0.002), particularly atrial fibrillation and low cardiac output syndrome. Multivariable analysis demonstrated that CE was not an independent predictor of mortality, whereas reduced left ventricular ejection fraction and prolonged CPB duration were significantly associated with increased mortality risk. Conclusion: Coronary endarterectomy was required in a small but clinically significant proportion of CABG patients and was associated with increased perioperative morbidity but not early mortality. When performed by experienced surgeons, CE remains a valuable adjunct for achieving complete revascularization in patients with diffuse coronary artery disease.