Multivessel Versus Single-Vessel Coronary Endarterectomy as an Adjunct to Coronary Artery Bypass Grafting: A Meta-Analysis of Short-Term Outcomes and Implications for Target-Vessel Selection
Abstract
Objectives: Coronary endarterectomy (CE) extends complete revascularization to patients with diffuse coronary disease unsuitable for conventional bypass but adds perioperative risk to coronary artery bypass grafting (CABG). Whether the number of vessels endarterectomized influences early outcomes has not been formally synthesized. We compared short-term outcomes of single-vessel and multivessel CE-CABG.
Methods: MEDLINE, Embase, and CENTRAL were searched for studies of CE-CABG reporting outcomes stratified by single-vessel vs multivessel CE within the same cohort. The primary outcome was 30-day or in-hospital mortality. Risk ratios (RR) were pooled using DerSimonian–Laird random-effects models. Sensitivity analyses included leave-one-out analysis, Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment, and univariate meta-regression on study-level covariates. Risk of bias was assessed with ROBINS-I.
Results: Nine studies (1988-2022; 7302 patients; 4731 single-vessel CE, 2571 multivessel CE) met inclusion criteria. Multivessel CE was associated with higher mortality (RR, 2.59; 95% CI, 1.78-3.77), higher perioperative myocardial infarction (RR, 2.09; 95% CI, 1.67-2.62), and higher stroke (RR, 1.62; 95% CI, 1.01-2.61). Intra-aortic balloon pump use did not differ. Findings were stable on leave-one-out, HKSJ adjustment, and exclusion of pre-2000 studies. No single covariate accounted for the multivessel effect on meta-regression.
Conclusions: Multivessel CE substantially increases early mortality and infarction relative to single-vessel CE. The signal is consistent across analyses but the evidence is largely retrospective and unadjusted. These data support a selective approach to CE in which the prognostic value of each target vessel is weighed against the cumulative operative cost, rather than routine extension of endarterectomy to multiple territories.
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BibTeX
@article{hon2026multivessel,
title = {{Multivessel Versus Single-Vessel Coronary Endarterectomy as an Adjunct to Coronary Artery Bypass Grafting: A Meta-Analysis of Short-Term Outcomes and Implications for Target-Vessel Selection}},
author = {Joshua J Hon and Arian Arjomandi Rad and Abdullah Tahir and Elisa Salagean and Marco Moscarelli and Dimitrios E Magouliotis and Roberto Casula and Thanos Athanasiou},
journal = {Interdisciplinary Cardiovascular and Thoracic Surgery},
year = {2026},
month = aug,
doi = {10.1093/icvts/ivag238},
url = {https://doi.org/10.1093/icvts/ivag238},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multivessel Versus Single-Vessel Coronary Endarterectomy as an Adjunct to Coronary Artery Bypass Grafting: A Meta-Analysis of Short-Term Outcomes and Implications for Target-Vessel Selection
AU - Joshua J Hon
AU - Arian Arjomandi Rad
AU - Abdullah Tahir
AU - Elisa Salagean
AU - Marco Moscarelli
AU - Dimitrios E Magouliotis
AU - Roberto Casula
AU - Thanos Athanasiou
PY - 2026
DA - 2026/08/26
JO - Interdisciplinary Cardiovascular and Thoracic Surgery
DO - 10.1093/icvts/ivag238
UR - https://doi.org/10.1093/icvts/ivag238
AB - Objectives: Coronary endarterectomy (CE) extends complete revascularization to patients with diffuse coronary disease unsuitable for conventional bypass but adds perioperative risk to coronary artery bypass grafting (CABG). Whether the number of vessels endarterectomized influences early outcomes has not been formally synthesized. We compared short-term outcomes of single-vessel and multivessel CE-CABG. Methods: MEDLINE, Embase, and CENTRAL were searched for studies of CE-CABG reporting outcomes stratified by single-vessel vs multivessel CE within the same cohort. The primary outcome was 30-day or in-hospital mortality. Risk ratios (RR) were pooled using DerSimonian–Laird random-effects models. Sensitivity analyses included leave-one-out analysis, Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment, and univariate meta-regression on study-level covariates. Risk of bias was assessed with ROBINS-I. Results: Nine studies (1988-2022; 7302 patients; 4731 single-vessel CE, 2571 multivessel CE) met inclusion criteria. Multivessel CE was associated with higher mortality (RR, 2.59; 95% CI, 1.78-3.77), higher perioperative myocardial infarction (RR, 2.09; 95% CI, 1.67-2.62), and higher stroke (RR, 1.62; 95% CI, 1.01-2.61). Intra-aortic balloon pump use did not differ. Findings were stable on leave-one-out, HKSJ adjustment, and exclusion of pre-2000 studies. No single covariate accounted for the multivessel effect on meta-regression. Conclusions: Multivessel CE substantially increases early mortality and infarction relative to single-vessel CE. The signal is consistent across analyses but the evidence is largely retrospective and unadjusted. These data support a selective approach to CE in which the prognostic value of each target vessel is weighed against the cumulative operative cost, rather than routine extension of endarterectomy to multiple territories.
SN - 2753-670X
ER -