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[Coronary revascularization by long endarterectomy and reconstruction]
P A Chaptal1, J R Séguin, J M Frapier
1Service de Chirurgie Thoracique et Cardiovasculaire, CHU, Hôpital Saint-Eloi, Montpellier.
Insights
Coronary endarterectomy and reconstruction offers a viable surgical option for diffuse coronary artery disease when bypass grafting is not feasible. This technique demonstrated promising results with no residual angina post-surgery in a recent patient series.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Reconstruction
Background:
- Coronary artery disease (CAD) management often involves bypass grafting.
- Diffuse CAD poses challenges for traditional revascularization methods.
- Endarterectomy and reconstruction present an alternative for select patients.
Purpose of the Study:
- To evaluate the efficacy and safety of endarterectomy and reconstruction for diffuse coronary artery disease.
- To assess the technique's applicability in patients unsuitable for coronary bypass grafting.
- To report early outcomes and graft patency.
Main Methods:
- Retrospective analysis of 55 patients undergoing coronary endarterectomy and reconstruction between May 1988 and April 1990.
- Patients had diffuse CAD, with 25 in NYHA class III and 30 in class IV angina.
- Coronary angiography confirmed double-vessel disease in 10 and triple-vessel disease in 45 patients.
Main Results:
- Four perioperative deaths (7.3%) and 10 perioperative myocardial infarctions (18.2%) were recorded.
- No residual angina was observed postoperatively.
- Follow-up angiography in 5 patients showed all grafts were patent and effectively revascularized the target arteries.
Conclusions:
- Coronary endarterectomy and reconstruction is a reliable technique for selected patients with diffuse CAD.
- The procedure is indicated for patients with extensive atheromatous disease not amenable to standard bypass grafting.
- Satisfactory early results suggest this method offers a reproducible approach to coronary revascularization.
Abstract:
Endarterectomy and reconstruction of the coronary arteries is a technique for patients with diffuse coronary disease and in whom coronary bypass grafting is contraindicated. In a serie of 418 patients undergoing coronary bypass between May 1988 and April 1990, 55 had endarterectomy and reconstruction of a coronary artery. The mean age was 62.2 years (44-80 years). Twenty-five patients had class III (NYHA) angina and 30 had class IV angina. On the coronary angiogram, 10 patients had double-vessel disease and 45 had triple vessel disease. Endarterectomy and reconstruction were performed on one coronary artery in 53 patients and on two coronary arteries in 2 patients. At mean of 2.6 grafts per patient were performed. Four patients died during the perioperative period. Ten had a perioperative myocardial infarction. No other complications were noted. No residual postoperative angina was present. Five patients had a follow-up angiogram during the first postoperative month. All grafts were patent and correctly revascularised the endarterectomised artery and branches. These satisfactory preliminary results suggest that endarterectomy and reconstruction of the coronary arteries is a reliable and reproducible technique for coronary grafting. It is indicated in patients with diffuse atheromatous coronary disease who were previously not considered for surgery.