Short-term clinical outcomes and mortality of coronary endarterectomy in the right coronary artery: A single-center experience

Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the only available alternative for cardiac surgeons in patients suffering from diffuse coronary artery disease. According to a large volume of studies, coronary endarterectomy results (such as survival, recurrence of the symptoms of myocardial ischemia, and graft patency) are not as satisfactory as standard coronary artery bypass grafting (CABG). While the left anterior descending artery (LAD) is the artery most commonly involved in coronary endarterectomy, RCA can be treated with coronary endarterectomy. This study aimed to evaluate clinical evidence and early results of right coronary artery endarterectomy. Methods: A total of 20 cases of coronary endarterectomy of the RCA was studied from January 2015 to January 2016 in this retrospective study. Endarterectomy procedure was performed in Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. Results: The mean age of the subjects was 60±5.2 years (range: 48-75 years).  From among them, 14 were male (70%), and the mean ejection fraction index was 36±5.7 (range: 15-60). Further, in 8 cases, a prior history of myocardial infarction was documented (40%). The mortality rate among patients was 10% (n=2). In total, 7 (35%) and 12 (60%) patients required intra-aortic balloon pump support and high-dose inotropic support, respectively. Perioperative myocardial infarction was observed in 5 (25%) cases, and 3 (15%) patients required re-exploration due to significant hemorrhage. Severe RV failure at the end of procedure was noticed in 4 patients (20%) with resultant mortality in half of them. Some type of heart block w occurred in 1 patient (5%). Conclusions: In case coronary endarterectomy of the RCA is performed by an experienced cardiac surgeon, favorable outcomes can be expected.