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Closed endarterectomy for diffuse right coronary artery disease: early results with angiographic controls
Nevzat Erdil1, Levent Cetin, Seref Kucuker
1Alkan Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. n_erdil@yahoo.com
Insights
Right coronary artery endarterectomy (RCE) with bypass grafting is safe for selected patients. This procedure did not increase mortality or morbidity compared to bypass alone, showing excellent short-term results.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Diffuse atherosclerosis of the right coronary artery (RCA) often deters surgical intervention due to high morbidity and mortality risks.
- Surgeons typically avoid endarterectomy (RCE) and bypass for such cases, opting for alternative strategies.
- This study investigates the outcomes of RCA endarterectomy combined with bypass grafting versus isolated bypass grafting.
Purpose of the Study:
- To compare the safety and efficacy of right coronary artery endarterectomy (RCE) with bypass grafting against isolated RCA bypass.
- To evaluate short-term clinical and angiographic outcomes in patients undergoing RCE and RCA bypass.
Main Methods:
- A retrospective comparison of 59 patients who underwent RCE with RCA bypass (RCE group) and 50 patients who had isolated RCA bypass (control group).
- Data collected from August 1998 to May 2000 at Alkan Hospital, including 1226 coronary artery bypass grafting (CABG) patients.
- Follow-up included clinical assessment for angina recurrence and control angiography at six months.
Main Results:
- The RCE group exhibited a higher incidence of diabetes but showed no statistically significant differences in mortality or morbidity compared to the control group.
- Postoperative cross-clamp time was significantly longer in the RCE group (33.5 ± 10 min vs. 27.3 ± 8 min, p < 0.05).
- At a mean follow-up of 7 ± 5 months, no angina recurrence was observed, and 100% graft patency was confirmed in 42 RCE patients who underwent angiography.
Conclusions:
- Endarterectomy for selected cases of diffusely diseased right coronary artery does not add significant mortality or morbidity to the CABG procedure.
- Short-term clinical and angiographic results for RCE combined with RCA bypass are excellent.
- This approach offers a viable option for managing complex right coronary artery disease.
Background:
Due to reported high morbidity and mortality, surgeons tend not to endarterectomize the diffusely diseased right coronary artery. Most prefer not to bypass this artery in such situation. We compared the endarterectomized right coronary patients with patients having total occlusion of right coronary artery not needing endarterectomy who received right coronary artery (RCA) bypass.
Material And Methods:
Between August 1998 and May 2000, 1226 patients had coronary artery bypass grafting (CABG) at Alkan Hospital, of whom 59 had right coronary artery endarterectomy (REC) along with RCA bypass with saphenous vein graft. We compared the results of 59 RCE patients with 50 patients who underwent RCA bypass without RCE.
Results:
Compared with the control group, the RCE group had a higher incidence of diabetes. There were no statistically significant differences between groups for mortality and morbidity. Among postoperative variables only the cross-clamp time was longer for the RCE group (33.5 +/- 10 min vs. 27.3 +/- 8 min, p < 0.05). Surviving patients were followed for a mean period of 7 +/- 5 months. No recurrence of angina occurred during the follow-up. Control angiography at the sixth month was performed on 42 RCE patients accepting the procedure, and all grafts were found patent.
Conclusion:
Endarterectomy for diffusely atherosclerotic right coronary artery for selected patients did not bring additional mortality and morbidity to the CABG procedure, and short term clinical and angiographic results were excellent.