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[Coronary endarterectomy]
Insights
Coronary endarterectomy combined with bypass grafting is safe and effective for diffuse coronary artery disease, particularly in the right coronary artery (RCA). While graft patency rates were lower than non-endarterectomy grafts, they were satisfactory, especially for RCA lesions.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) management often involves coronary artery bypass grafting (CABG).
- Diffuse CAD may necessitate adjunct procedures like endarterectomy.
- The efficacy and safety of coronary endarterectomy as an adjunct to CABG require evaluation.
Purpose of the Study:
- To assess the safety and efficacy of coronary endarterectomy as an adjunct to CABG.
- To evaluate graft patency rates in patients undergoing coronary endarterectomy.
- To compare outcomes between endarterectomy and non-endarterectomy groups.
Main Methods:
- Retrospective analysis of 314 patients undergoing CABG between July 1984 and December 1986.
- 70 patients (22%) required coronary endarterectomy (END group).
- Early postoperative angiography (4 weeks) assessed graft patency in 54 patients.
Main Results:
- The overall hospital mortality rate for the END group was 7%; perioperative myocardial infarction occurred in 7% of patients.
- Patency rates for RCA endarterectomy were 81.8%, and for LCA endarterectomy were 75%.
- Non-endarterectomy grafts had a patency rate of 86.6%; however, endarterectomy likely improved patency in selected cases, especially for RCA lesions.
Conclusions:
- Coronary endarterectomy is a safe and useful adjunct to CABG for diffuse CAD.
- Outcomes for right coronary artery (RCA) endarterectomy were satisfactory and superior to left coronary artery (LCA) endarterectomy.
- Coronary endarterectomy is particularly beneficial for managing diffuse disease in the RCA system.
Abstract:
From July, 1984, to December, 1986, coronary bypass grafting was performed in 314 patients, 70 (22%) requiring coronary endarterectomy (RCA; 48 pts, LAD; 10 pts, LAD + RCA; 10 pts, Others; 2 pts). Coronary endarterectomy patients (END group) were younger and often with the risk factor of hyperlipidemia than non-endarterectomy patients (NON group). The over-all hospital mortality rate of END group was 7 per cent; perioperative myocardial infarction occurred in 7 per cent of patients. Early postoperative angiogram (4 weeks after the operation) was performed in 54 patients. The patency rate of RCA endarterectomy was 81.8 per cent, and that of LCA endarterectomy was 75 per cent. This result was poor compared with the patency rate of non-endarterectomy graft (86.6%). However without endarterectomy, with all likelihood the patency rate of those grafts would have been poorer. The results of right coronary endarterectomy are satisfactory and better than those of the left coronary artery system. This experience suggests that coronary endarterectomy is safe and an useful adjunct of saphenous vein bypass grafting procedures in the management of diffuse coronary disease, especially in RCA lesions.