Related Experiment Videos
Our experience with surgical management of patients with diffuse coronary artery disease
Insights
Multiple coronary artery bypass grafting combined with endarterectomy is a safe and effective treatment for severe diffuse coronary artery disease, improving symptoms and exercise tolerance with low mortality.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Severe diffuse triple-vessel coronary artery disease poses significant treatment challenges.
- Patients often present with poor left ventricular ejection fraction and left main coronary artery disease.
- Standard surgical approaches may be insufficient for complex coronary anatomy.
Purpose of the Study:
- To evaluate the safety and efficacy of combined coronary artery bypass grafting (CABG) and endarterectomy for severe diffuse coronary artery disease.
- To assess peri-operative mortality, long-term functional outcomes, and changes in ejection fraction.
Main Methods:
- A prospective study of 145 consecutive patients undergoing CABG with endarterectomy between January 1983 and December 1988.
- Detailed recording of patient demographics, pre-operative conditions, surgical procedures, and post-operative outcomes.
- Follow-up included clinical assessment of angina symptoms and radionuclide ventriculography to evaluate ejection fraction.
Main Results:
- Peri-operative mortality was 3.5%.
- Post-operatively, 86% of patients improved to Canadian Cardiovascular Society Class I angina symptoms within 2 years.
- Radionuclide ventriculography showed significant improvement in ejection fraction response to exercise (p < 0.05).
Conclusions:
- Combined CABG and endarterectomy is a viable option for patients with severe diffuse coronary artery disease, including those with impaired left ventricular function.
- The procedure offers low mortality rates and leads to significant improvements in exercise tolerance and functional status.
- This surgical strategy effectively addresses complex coronary artery disease, improving patient outcomes.
Abstract:
During a follow up period of 5 years (January 1983-December 1988), 145 consecutive patients (14% of all patients undergoing coronary artery bypass surgery) underwent multiple coronary artery bypass grafting combined with endarterectomy whenever necessary for treatment of severe diffuse triple-vessel coronary artery disease. Fifty-one patients (35%) had poor left ventricular ejection fraction (less than 35%). Associated left main coronary artery disease was present in 30 (21%) patients. All coronary arteries and branches with greater than 50% obstructive disease were bypassed, using saphenous vein conduit; average grafts per patient were 5.5. Endarterectomies were done in 137 patients in 210 vessels. Right coronary artery was the commonest site (132 patients). Multiple vessel endarterectomy (greater than 2 vessels) was done in 44 patients (30%). The peri-operative mortality was 3.5%. Pre-operatively, 75% patients had class III and 14% class IV (Canadian Cardiovascular Society angina criteria). During the mean follow up period of 2 years, 86% patients have class 1 symptoms, and 14% have class II symptom. Thirty of these 145 patients have undergone resting and exercise radionuclide ventriculographic studies which have shown a significant improvement in the ejection fraction response to exercise (p less than 0.05). Thus, patients with severe diffuse coronary disease can undergo multiple bypass grafting procedure, along with endarterectomies with low mortality rates and improved exercise tolerance and functional classification.