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Surgical revascularisation for diffuse CAD--an experience in 116 cases
Insights
Coronary endarterectomy with patch angioplasty effectively treats diffuse coronary artery disease, improving angina and effort tolerance in over 95% of patients. This safe procedure offers an alternative when bypass grafting alone is insufficient.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Patients with severe triple vessel disease and angina pectoris often present with complex comorbidities.
- Medical management and traditional bypass grafting may be insufficient for diffuse coronary artery disease.
- The increasing prevalence of percutaneous coronary interventions and repeat bypass surgeries leads to patients with more advanced disease.
Purpose of the Study:
- To evaluate the efficacy and safety of coronary endarterectomy with patch angioplasty for diffuse coronary artery disease.
- To assess clinical outcomes, including angina relief and functional improvement.
- To determine the long-term effectiveness of this surgical approach.
Main Methods:
- A cohort of 116 patients (94 male, 22 female) with severe triple vessel disease underwent endarterectomy with patch angioplasty.
- Procedures included saphenous vein grafts (86%) and internal mammary artery grafts (12%).
- Patients were followed up for a mean of 18 months (range 10-43 months).
Main Results:
- No operative mortality was observed.
- Perioperative infarct rate was 2.7%.
- Over 95% of patients were clinically free from angina pectoris with improved effort tolerance post-surgery.
Conclusions:
- Coronary endarterectomy with patch angioplasty is an effective and safe treatment for diffuse coronary artery disease.
- This technique provides a valuable option for patients unsuitable for bypass grafting alone.
- The incidence of diffuse coronary artery disease is expected to rise, highlighting the importance of such surgical interventions.
Abstract:
There were 94 male and 22 female, age ranges 32 to 71 years with a mean age of 54 years. All of them had angina pectoris and strong positive stress test inspite of maximum medical treatment. All had severe triple vessel disease including (12 (10%) had critical left main stem lesion, 68 (52%) were diabetic and hypertensive, 51 (44%) had myocardial infarct with 16 (14%) of them showing global hypokinesia of ejection fraction 30%. The average grafts per patient was 3.8 Seventy-nine patients (68%) and RCA endarterectomy; 19 (16%) had right and left coronary endarterectomy and 18 (15%) had left coronary artery endarterectomy. One-hundred and three (86%) were reconstructed with saphenous vein graft. 13 (12%) with IMA grafts. There was no operative mortality. Two hospital deaths and two late deaths occurred in those patients who had very poor left ventricular function. The perioperative infarct rate was 2.7%. All patients were followed-up regularly at 2 weeks, 3 months, 6 months, postoperatively. The mean follow-up was 18 months ranging 10 to 43 months. Clinically over 95% are free from angina pectoris with improved effort tolerance. We conclude that endarterectomy with patch angioplasty is an effective and safe procedure in treating Diffuse Coronary Artery Disease which cannot be treated by bypass alone. The incidence of Diffuse Coronary Artery Disease is likely to increase in the future as the percutaneous balloon angioplasty is becoming more widely practised and Re-do CABG patient would come to surgery at a more advanced state of the disease.
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