Results of coronary artery endarterectomy and reconstruction

Since 1978, 5005 patients have had coronary artery bypass operations: 50% had conventional grafts only (group A), 25.1% required one coronary artery endarterectomy (group B), and 24.9% required multiple endarterectomies (group C). Operative mortality and long-term survival were stratified within each group according to the presence of additional risk factors: severe left ventricular dysfunction, repeat operation, insulin-dependent diabetes mellitus, female sex, and age over 70 years. Operative mortality was 4.0% in group A patients, 6.3% in group B, and 10.4% in group C; it increased in each group as the number of risk factors increased. Mortality was higher in patients with a left coronary artery endarterectomy compared to those with a right coronary endarterectomy only when multiple risk factors were present. Perioperative myocardial infarction occurred in 5.6% of group A patients, 6.5% of group B, and 13.1% of group C patients. Early graft patency (940 patients, 18.8%) was 801 of 901 (88.9%) for endarterectomy grafts and 2939 of 3248 (90.5%) for conventional grafts. Late patency (over 1 year) in 288 symptomatic patients was 137 of 191 (71.1%) for endarterectomy grafts and 644 of 850 (75.8%) for conventional vein grafts. Long-term (5-year) actuarial survival rate was reduced in patients requiring endarterectomy. Current anginal status is available for 3011 of 3305 patients (91.1%): 28.9% of group A patients, 32.5% of group B, and 33.7% of group C patients have recurrent angina at an average follow-up of 58.3 months. The results of this study show increased operative mortality and morbidity in patients requiring coronary artery endarterectomy and reconstruction. However, the early results and particularly the late survival, clinical status, and continued graft patency justify this approach in patients with diffuse coronary artery disease, many of whom would otherwise be inoperable.