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[Results of endarterectomy in coronary artery surgery (author's transl)]
Insights
Coronary artery endarterectomy with saphenous vein grafts showed an 83.9% patency rate. However, high hospital mortality necessitates stricter indications for this surgical procedure.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Context:
- Aortocoronary bypass procedures
- Coronary artery disease management
Purpose:
- Evaluate outcomes of coronary artery endarterectomy
- Assess graft patency and mortality rates
Summary:
- Endarterectomy was performed on 60 coronary arteries in 58 patients undergoing aortocoronary bypass.
- Saphenous vein grafts were used in most cases, with a high patency rate of 83.9% at 5.2 months.
- Hospital mortality was significant (19%), particularly in patients with three-vessel disease and prior myocardial infarctions.
Impact:
- High mortality suggests a need for revised indications for coronary endarterectomy.
- Preoperative imaging may not always accurately predict local arterial conditions.
- Further research needed to refine patient selection for improved surgical outcomes.
Abstract:
In a series of 432 aortocoronary bypass procedures endarterectomies were performed in 58 patients (13.4%) on 60 coronary arteries. Except of two vein patch grafts all endarterectomized arteries were bypassed with a saphenous vein graft. The majority of the patients had an endarterectomy of the right coronary artery. Clinical control investigations were performed in 43 out of 47 survivors including 30 with coronary angiograms 5.2 months (mean) after surgery. 26 out of 31 endarterectomized arteries (83.9%) were open angiographically whereas the patency rate to non-endarterectomized arteries of the same patients was 86.4%. The hospital mortality was high; 11 out of 58 patients (19%) deceased. All patients who died postoperatively had a three vessel disease with diffuse coronary sclerosis. Only three had no myodardial infarction prior to surgery, seven had one to four infarctions before surgery. The relatively high mortality intends for the future a more strict revision of the indications for coronary surgical procedures. But not in all cases the preoperative coronary angiograms and ventriculograms allow a clear estimation of the local arterial conditions.