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Outcome of coronary endarterectomy: a case-control study
G Asimakopoulos1, K M Taylor, C P Ratnatunga
1Cardiothoracic Unit, Hammersmith Hospital, Imperial College School of Medicine, London, England.
Insights
Coronary endarterectomy, an adjunct to bypass grafting, shows acceptable outcomes in selected patients. This study found similar survival and angina recurrence rates compared to a control group, suggesting its continued utility in specific cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary endarterectomy is used with coronary artery bypass grafting for diffusely diseased arteries.
- Despite historical concerns regarding morbidity and mortality, its role warrants reevaluation due to evolving patient demographics and surgical techniques.
Purpose of the Study:
- To reevaluate the role and outcomes of coronary endarterectomy as an adjunct to coronary artery bypass grafting.
- To compare the postoperative morbidity and medium-term results of coronary endarterectomy with a matched control group.
Main Methods:
- Retrospective review of 56 patients undergoing coronary endarterectomy between January 1993 and August 1996.
- Comparison with a control group of 56 matched patients (age, sex, LV function, angina class).
- Mean follow-up of 21 months.
Main Results:
- Coronary endarterectomy was performed on one to three coronary arteries in 96.4% of patients.
- The right coronary artery was most frequently involved (51.5%), followed by the left anterior descending (31.3%).
- Nonfatal myocardial infarction occurred in 5.4% of the endarterectomy group versus 0% in controls (p>0.05). Thirty-day mortality was 3.6% in the endarterectomy group versus 0% in controls (p>0.05). Actuarial survival and recurrent angina rates were similar between groups.
Conclusions:
- Coronary endarterectomy demonstrates satisfactory postoperative morbidity and medium-term results in carefully selected patient groups.
- The procedure can be considered a viable option in current cardiac surgical practice for specific indications.
Background:
Despite early reports showing a high incidence of postoperative morbidity and mortality, coronary endarterectomy continues to be used as an adjunct to coronary artery bypass grafting, particularly in diffusely diseased coronary arteries. The changing nature of patients and improvements in modern cardiac surgery call for a reevaluation of the role of coronary endarterectomy.
Methods:
Data from the 56 patients, who underwent coronary endarterectomy in our institution between January 1993 and August 1996, were reviewed retrospectively and compared with a control group of 56 patients matched for age, sex, LV function, and angina class. In the endarterectomy group, there were 47 men and nine women, with a mean age of 59.6 years. The mean follow-up time was 21 months. Indications for operation were angina in 45 (80.3%), angina with signs or symptoms of cardiac failure in 3 (5.4%), and prognosis in 8 (14.3%) asymptomatic patients.
Results:
Fifty (89%) patients had one, four (7.2%) had two, and 2 (3.6%) patients had three coronary arteries endarterectomized. Of these 64 endarterectomies, 33 (51.5%) involved the right coronary artery, 20 (31.3%) the left anterior descending artery, and 11 (17.2%) branches of the circumflex artery. There were three (5.4%) nonfatal myocardial infarctions in the endarterectomy group, but none in the control group (p>0.05). Two patients (3.6%) in the endarterectomy group, but none in the control group, died within the first 30 days (p>0.05). Actuarial survival and incidence of recurrent angina were similar in the two groups.
Conclusions:
In current cardiac surgical practice, coronary endarterectomy displays satisfactory rates of postoperative morbidity and medium term results in selected groups of patients.