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Bypass grafting with coronary endarterectomy: immediate and long-term results
Giuseppe Marinelli1, Bruno Chiappini, Marco Di Eusanio
1Departments of Cardiovascular Surgery and Cardiology, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
Insights
Coronary endarterectomy combined with bypass grafting is safe and effective for complete revascularization in end-stage coronary disease, showing good long-term survival and symptom relief.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy has been linked to increased morbidity and mortality.
- This study retrospectively reviewed outcomes of CABG with coronary endarterectomy.
Purpose of the Study:
- To evaluate the early and late outcomes of coronary bypass with endarterectomy.
- To identify independent predictors of early mortality and morbidity associated with this combined procedure.
Main Methods:
- Retrospective review of 107 patients undergoing myocardial revascularization with coronary endarterectomy between May 1989 and December 2000.
- Analysis of patient demographics, comorbidities (previous myocardial infarction, emergency surgery, low ejection fraction), and procedural details.
- Long-term follow-up obtained from 97 survivors (100% of long-term survivors).
Main Results:
- The study reported an early mortality rate of 4.7% (5 deaths).
- 72-month survival was 91.2% +/- 4.9%, with 83.7% of survivors symptom-free.
- Echocardiography and angiography showed improved ejection fraction post-operation (P =.03), and a 30.4-month patency rate of 72% +/- 11% for endarterectomized arteries.
Conclusions:
- Coronary endarterectomy is a safe and effective procedure.
- It facilitates complete revascularization in patients with end-stage coronary artery disease.
Background:
Increased morbidity and mortality have been associated with coronary artery bypass grafting when an adjunctive coronary endarterectomy is performed. In this study we retrospectively reviewed our experience with coronary bypass and endarterectomy to evaluate the early and late outcome and to determine the independent predictors of early mortality and morbidity of this procedure.
Methods:
Between May 1989 and December 2000, 107 patients underwent myocardial revascularization with coronary endarterectomy to achieve a complete revascularization. There were 90 men and 17 women; the mean age was 64 +/- 8.1 years. Sixty-three (58.9%) patients had a previous myocardial infarction, and 29 (27.1%) were operated on on an emergency basis. An ejection fraction of less than 30% was present in 9 (8.4%) patients. The most frequently endarterectomized vessel was the left coronary artery (74.8%). Follow-up information was obtained from 97 patients (100% of the long-term survivors).
Results:
There were 5 (4.7%) early deaths. The 72-month survival was 91.2% +/- 4.9%. Seventy-seven (83.7%) of the survivors were symptom free, and 15 (16.3%) were in Canadian Cardiovascular Society class II to III. An improvement of the ejection fraction after the operation was shown in the 97 patients who underwent echocardiographic control (P =.03) and angiography. The 30.4-month patency rate of the endarteriectomized coronary arteries was 72% +/- 11%.
Conclusion:
Coronary endarterectomy is a safe and effective procedure for achieving a complete revascularization in patients with end-stage coronary disease.
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