[Multiple coronary endarteriectomy in patients with diffusial coronary disease]

In recent years the profile of patients with CAD is continuously changing, often with previous operation or stenting. Multiple coronary endarterectomies have been utilized as an adjunct to CABG in this select group of patients to achieve complete revascularization because of the diffuse CAD.

Between January 1997 and December 2001 eighty eight consecutive patients undergoing first time CABG with more than two CE were compared with a control group of 967 patients undergoing CABG without CE.

More than 9% of the CABG patients need two or more endarterectomies, with involvement of the RCA in 96% and LAD in 59%. The extended time of aortic clamping and the higher rate of perioperative MI lead to higher mortality in Group 1 without significant difference between groups. The 5 years survival was 69% in Group 1 and 84% in Group 2.

The operative results--mortality and morbidity, are similar in both groups instead of the highest complexity of the procedures with multiple endarterectomies. The use of this method together with CABG allows complete revascularization in 10% of the operated patients with diffuse atherosclerosis.