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Angiographic assessment of graft patency after coronary endarterectomy
J Goldstein1, E Cooper, A Saltups
1Prince Henry's Hospital, Melbourne, Australia.
Insights
Coronary endarterectomy with bypass grafting showed high early graft patency but poor long-term results. This procedure should be reserved for select, inoperable coronary vessels.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease management often involves bypass grafting.
- Coronary endarterectomy is a potential adjunct for treating atheromatous vessels.
- Long-term outcomes of coronary endarterectomy combined with bypass grafting require evaluation.
Purpose of the Study:
- To assess the early and late outcomes of manual core endarterectomy combined with coronary bypass grafting.
- To evaluate the patency rates of grafts to endarterectomized coronary vessels over time.
- To characterize the angiographic changes in endarterectomized coronary segments.
Main Methods:
- A consecutive series of 51 patients underwent manual core endarterectomy and coronary bypass grafting.
- Early (mean 19 days) and late (mean 19 months) repeat angiography were performed on consenting patients.
- Graft patency and angiographic appearance of endarterectomized segments were analyzed.
Main Results:
- One operative death (2%) occurred.
- Early graft patency to endarterectomized vessels was high (90%, 47/52).
- Late graft patency significantly decreased to 64% (27/42), with observed vessel "shrinkage" and fibrosis.
Conclusions:
- Coronary endarterectomy provides excellent early graft patency but demonstrates accelerated deterioration and low late patency.
- The procedure should be reserved for coronary vessels that are otherwise inoperable and supply a moderate-sized coronary bed.
Abstract:
Fifty-one consecutive patients underwent 68 manual core endarterectomies between April 1985 and May 1987. There were 42 men and nine women, mean age 60 years (range 39 to 81). All patients underwent coronary bypass grafting alone. There were no reoperations. There was one operative death (2%). Forty patients consented to early (mean 19 days) and 27 to late (mean 19 months) repeat angiography. At the early restudy 47 of 52 (90%) grafts to endarterectomized vessels were patent. This rate fell to 27 of 42 (64%) at late restudy. There was considerable variation in the angiographic appearance of the endarterectomized vessels, ranging from a large caliber, smooth walled vessel to an attenuated vessel with irregular walls. In general, there was a tendency toward "shrinkage" of these vessels by the late restudy, suggesting fibrosis in the walls. We conclude that, although endarterectomy can be done on most atheromatous vessels with excellent early graft patency, these vessels tend to show an accelerated deterioration with time, resulting in a low late patency rate. We suggest that the procedure be reserved for vessels that are truly inoperable by other means and only for vessels that supply a coronary bed of at least moderate size.