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Coronary endarterectomy--angiographic and clinical results
1Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Insights
Coronary endarterectomy, often unplanned, treated severe multi-vessel disease. While associated with perioperative risks like myocardial infarction, it offered significant angina relief and good long-term survival rates.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery disease frequently involves complex multi-vessel pathologies.
- Surgical interventions for severe coronary artery disease require careful consideration of risks and benefits.
Purpose of the Study:
- To evaluate the outcomes of coronary endarterectomy in patients with severe coronary artery disease.
- To assess the safety, graft patency, and long-term survival following coronary endarterectomy.
Main Methods:
- Retrospective analysis of 75 patients undergoing coronary endarterectomy.
- Inclusion of graft patency assessment via angiography and evaluation of clinical outcomes, including angina relief and survival rates.
Main Results:
- High prevalence of three-vessel disease (53%) and unplanned endarterectomies (91%).
- Early mortality (5%) and perioperative myocardial infarction (19%) were observed, particularly after left anterior descending endarterectomy.
- Graft patency rates were favorable for internal mammary artery grafts (100%) and saphenous vein grafts (56%) to endarterectomized vessels.
- Significant angina relief (92%) and 5-year (85%) and 10-year (68%) survival rates were achieved.
Conclusions:
- Coronary endarterectomy can be a viable option for selected patients with severely diseased major coronary arteries.
- Despite increased perioperative risks, the procedure offers substantial long-term benefits in terms of symptom relief and survival.
Abstract:
Of 75 patients who underwent coronary endarterectomy, 16% had left main stem stenosis, 4% one-vessel, 27% two-vessel and 53% three-vessel disease. On average 2.9 grafts per patient were inserted, in conjunction with 82 manual endarterectomies (38 right coronary, 35 left anterior descending, 9 circumflex branches). In 68/75 cases (91%) the endarterectomy was not preplanned and in 39 cases (52%) greater than or equal to 3 cm of the atherosclerotic core was removed. All four early deaths (5%) followed endarterectomy of LAD. Acute perioperative myocardial infarction was confirmed in 19% and probable in further 8%. At angiography 1-139 (median 25) months postoperatively, all three internal mammary artery grafts and 19/34 saphenous vein grafts (56%) to endarterectomized vessels were patent, though in 4 of the 19, the coronary artery was occluded distal to the anastomosis. In addition 17/18 conventional internal mammary artery (94%) and 48/59 conventional saphenous vein grafts (81%) were patent. The vein graft patency rate was not significantly influenced by postoperative anticoagulant therapy, but was significantly increased among patients with relief of angina: 44% reported freedom from angina and 92% at least some relief after a median of 3 years. The 5-year and 10-year survival rates were 85% and 68%. Despite the increased risk, endarterectomy can be recommended for severely diseased major coronary arteries.
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