Results of right coronary artery endarterectomy with or without patchplasty

We report preoperative and early postoperative findings of 286 coronary bypass patients operated between 1988 and 1998 who had endarterectomy and/or patchplasty to the right coronary artery. In this retrospective study there were 61 cases with only saphenous vein patchplasty to the right coronary artery (patch group), 57 patients who underwent endarterectomy and patchplasty (open-patch group), and 229 patients having closed endarterectomy to the right coronary artery (closed group). A group of 150 patients having a saphenous vein graft to the right coronary artery without endarterectomy were chosen as a control group. Gender, age, family history, smoking history, diabetes, hyperlipidemia, hypertension, nature of the angina, severity of the coronary artery disease, left ventricular functions, preoperative rhythm, and electrocardiographic patterns were evaluated for their effect on early mortality among groups. No significant difference was detected. Positive inotropic and mechanical support need was higher in the closed group at the end of the operation and in the intensive care unit. Duration of cardiopulmonary bypass and clamp time was higher in the open-patch group. Atrial fibrillation in the early postoperative period was more frequent in the patch and closed groups. Complete atrioventricular block development and the need for a pacemaker were higher in the open-patch and closed groups. Non-Q wave myocardial infarction was more frequent in the closed group. Mortality rates were higher in the open-patch and closed groups. We conclude that endarterectomy to right coronary artery should be avoided if possible, and patchplasty with saphenous vein should be preferred.