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Published on: March 27, 2018
Combined gas endarterectomy and coronary artery bypass graft. A follow-up study
Insights
Combined gas endarterectomy and bypass grafting showed a 91% survival rate at 3 years. This procedure led to significant symptomatic improvement in 96% of patients with arterial disease.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease necessitates advanced surgical interventions.
- Combined endarterectomy and bypass grafting offers a potential solution for complex arterial blockages.
Purpose of the Study:
- To evaluate the long-term outcomes of combined gas endarterectomy and bypass grafting.
- To assess survival rates, mortality, graft patency, and symptomatic improvement.
Main Methods:
- Follow-up of 104 patients undergoing combined gas endarterectomy and bypass grafting.
- Actuarial survival analysis and graft patency assessment via repeat angiography.
- Evaluation of perioperative infarction and left ventricular function.
Main Results:
- Early (2.9%) and late (3.8%) mortality observed, primarily in heart failure patients.
- 3-year actuarial survival rate of 91%.
- 87% graft patency rate with good runoff in 75% of patients; 96% symptomatic improvement.
Conclusions:
- Combined gas endarterectomy and bypass grafting demonstrates favorable long-term survival and significant symptomatic benefits.
- Graft patency remains stable over time, correlating with clinical improvement.
- The procedure is effective for managing complex arterial disease, with low rates of significant complications.
Abstract:
One hundred and four patients who underwent combined gas endarterectomy and bypass grafting were followed for periods up to 4 1/2 years (mean, 15 months). The early mortality was 2.9% and the late mortality 3.8%; all of these deaths occurred in patients operated on for heart failure. The survival rate, presented in an actuarial manner, was 91% for the whole group at 3 years. Perioperative infarction occurred in 5.8%, was usually accompanied by patent grafts, and produced left ventricular dysfunction in only 1 of 5 patients investigated. Symptomatic improvement was observed in 96% of the patients. There was fairly good correlation between symptomatic improvement and graft patency. Repeat graft and coronary angiography showed that of 65 grafts to endartectomized arteries, 56 were patent (a patency rate of 87%); there was no evidence of decrease of patency rate with time, and no significant difference between patency rates of grafts to different arteries. The runoff of patent grafts was judged to be good in 75% of patients, moderate in 15% and poor in 10%.
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