3 years ago

Endarterectomía coronaria y cirugía de revascularización

Daniel Pérez-camargo, Mónica García-bouza, Bunty Ramchandani, Javier Cobiella-carnicer, Enrique Villagrán-medinilla, Manuel Carnero-alcazar, Luis C. Maroto-castellanos

Publication date: Available online 16 August 2018

Source: Cirugía Cardiovascular

Author(s): Daniel Pérez-Camargo, Mónica García-Bouza, Bunty Ramchandani, Javier Cobiella-Carnicer, Enrique Villagrán-Medinilla, Manuel Carnero-Alcazar, Luis C. Maroto-Castellanos

Resumen
Introducción

La ateromatosis coronaria difusa actualmente es un reto para el cirujano cardiaco. La endarterectomía coronaria es un procedimiento útil para el tratamiento de esta enfermedad en conjunto con la cirugía de revascularización. Actualmente existe poca evidencia del impacto de la endarterectomía coronaria en la supervivencia a largo plazo de la cirugía de revascularización miocárdica.

Objetivos

Analizar y comparar supervivencia y eventos adversos cardiovasculares mayores de la endarterectomía en la cirugía coronaria a corto y largo plazo.

Material y métodos

Revisión retrospectiva de los pacientes sometidos a cirugía coronaria aislada, comparando endarterecomías vs revascularización aislada. Comparación de supervivencia a largo plazo en la cohorte total y análisis de riesgos proporcionados de Cox para la supervivencia. Comparación de eventos adversos cardiovasculares en una muestra ajustada mediante propensity score.

Resultados

Media de seguimiento: 5,9 años (±3,9). Ciento siete pacientes sometidos a endarterectomía y 1.936 a revascularización aislada, a 10 años. La supervivencia fue del 62% y del 70% (p = 0,044) para el grupo de endarterectomía y revascularización aislada, respectivamente. La endarterectomía fue un factor de riesgo independiente para mortalidad (HR: 1,6; IC 95%: 1,1-2,3). En la muestra ajustada observamos una mayor incidencia de eventos adversos cardiovasculares perioperatorios (23,8% vs 10,4%; p < 0,000) y a largo plazo (35% vs 54%; p = 0,015).

Conclusiones

La endarterectomía se asocia a mayor incidencia de eventos adversos cardiovasculares perioperatorios, principalmente debido a infarto agudo de miocardio. A largo plazo, la endarterectomía es un factor de riesgo independiente para mortalidad.

Abstract
Introduction

Diffuse coronary artery disease is a challenge for the Cardiac Surgeon. Coronary endarterectomy is a useful procedure for the management of this condition as an adjunct to coronary artery bypass grafting. Currently, there's limited evidence about long term outcomes after coronary endarterectomy as an adjunct to coronary artery revascularization.

Objectives

Analyze and compare major adverse cardiovascular events in coronary endarterectomy.

Material and methods

Retrospective review of patients who underwent coronary artery surgery, comparing patients with an endarterectomy and those with isolated coronary surgery. We compared long term survival in the total cohort and performed a proportional hazard risks analysis for survival. Also, we compared adverse cardiovascular events in a propensity score matched cohort.

Results

Mean follow-up: 5,9 years (±3,9). 107 patients underwent endarterectomy, 1936 isolated coronary surgery. 10-year survival were 62% vs 70% (p = 0,044) respectively. Coronary endarterectomy was identified as an independent risk factor for this event (HR: 1,6; 95% CI: 1,1-2,3). On the adjusted cohort, we observed a higher incidence of perioperative (23,8% vs 10,4%; P < .000) and long term (35% vs 54%; P = .015) major adverse cardiovascular events for the endarterectomy group.

Conclusions

Coronary endarterectomy is associated to a higher incidence of perioperative major adverse cardiovascular events, mainly because of a higher incidence of myocardial infarction. At long term, coronary endarterectomy was identified as an independent risk factor for mortality.

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