Outcome of coronary endarterectomy: a case-control study

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.

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.

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.

In current cardiac surgical practice, coronary endarterectomy displays satisfactory rates of postoperative morbidity and medium term results in selected groups of patients.