Long-term angiographic results of coronary endarterectomy
V A Ferraris1, J D Harrah, D M Moritz
1Department of Cardiovascular Services, Marshall University School of Medicine, Huntington, West Virginia 25701, USA. ferraris@earthlink.net
Insights
Coronary endarterectomy (CE) bypass grafts show lower long-term patency than non-CE grafts. Larger body size predicts CE graft patency, while hypertension and smoking reduce non-CE graft patency.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Assessing long-term patency of coronary endarterectomy (CE) in bypass grafting.
- Evaluating outcomes of CE compared to conventional bypass grafting.
Purpose of the Study:
- To determine the long-term patency rates of coronary artery bypass grafts (CABG) to endarterectomized versus non-endarterectomized vessels.
- To identify predictors of graft patency after CE and CABG.
Main Methods:
- Retrospective analysis of 97 patients undergoing CE and 154 control patients post-CABG.
- Analysis of 41 clinical and angiographic variables.
- Mean follow-up of 7.1 years with repeat catheterization.
Main Results:
- Graft patency to endarterectomized vessels was significantly lower (40%) compared to non-endarterectomized vessels (58-65%).
- Age-adjusted body surface area was the sole predictor of long-term CE graft patency.
- Hypertension, smoking, and use of mammary artery grafts influenced non-endarterectomized vessel graft patency.
Conclusions:
- Long-term patency of bypass grafts to endarterectomized vessels is less favorable than to non-endarterectomized vessels.
- Larger body size is associated with better CE graft patency.
- Aggressive risk factor control is crucial for patients undergoing CE, particularly smaller individuals.
Background:
To evaluate the long-term patency of endarterectomized coronary vessels, we studied patients having recatheterization after coronary artery bypass grafting.
Methods:
Forty-one clinical and angiographic variables were analyzed in 97 study patients who had coronary endarterectomy (CE) and in 154 control patients who did not have CE but who had repeat catheterization after coronary artery bypass grafting.
Results:
Ninety-seven patients had 132 CEs. The right coronary artery was the most commonly endarterectomized vessel (73 of the 132 endarterectomized vessels). At a mean of 7.1 years of follow-up, significantly fewer bypass grafts to endarterectomized vessels were patent compared with nonendarterectomized vessels (40% of endarterectomized vessels compared with 58% of nonendarterectomized vessels in study patients and 65% in control patients, p = 0.0003). The only predictor of long-term CE graft patency is age-adjusted body surface area (p = 0.0068). Patency in grafts to nonendarterectomized vessels is diminished by hypertension (p = 0.046) and current cigarette use (p = 0.024) and improved by use of mammary artery grafting (p < 0.0001).
Conclusions:
These results show that long-term patency in bypass grafts to endarterectomized vessels is less common than in nonendarterectomized vessels and that this patency is related to larger body size. Patency in nonendarterectomized vessels is reduced by risks of arteriosclerosis. This suggests that CE should be used with caution in smaller patients and that aggressive control of risk factors for atherogenesis is particularly important in patients who have CE. On the basis of these results, we speculate that the extent of disease is advanced in patients who require CE.
