Triple vessel coronary artery endarterectomy and reconstruction: results in 144 patients
J B Brenowitz1, K L Kayser, W D Johnson
1Division of Thoracic Surgery, St. Mary's Hospital, Milwaukee, Wisconsin.
Insights
Coronary artery endarterectomy and reconstruction can revascularize diffusely diseased arteries. This study found a 3.8% operative mortality in low-risk patients, with 5-year survival reaching 87% for this group.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is standard for coronary artery disease.
- Diffusely diseased coronary arteries present challenges for conventional CABG.
- Endarterectomy and reconstruction offer alternative revascularization strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of coronary artery endarterectomy and reconstruction in patients with diffusely diseased coronary arteries.
- To identify risk factors associated with operative mortality in this patient population.
- To assess long-term survival rates following these procedures.
Main Methods:
- A consecutive series of 144 patients underwent endarterectomy and reconstruction of major coronary arteries.
- Operations were performed using intermittent ischemic arrest.
- Patient data, including preoperative risk factors, operative details, and long-term outcomes, were analyzed.
Main Results:
- The overall operative mortality was 10% (14 deaths), with cardiac causes predominating.
- Significant risk factors for mortality included repeat surgery, ejection fraction ≤0.30, and age ≥70 years.
- Low-risk patients (n=106) had a 3.8% operative mortality and a 5-year survival rate of 87%.
Conclusions:
- Coronary artery endarterectomy and reconstruction are viable adjuncts for revascularizing diffusely diseased coronary arteries.
- Patient selection is crucial, with lower mortality and higher survival rates observed in low-risk individuals.
- These techniques can achieve favorable long-term outcomes when applied appropriately.
Abstract:
Coronary artery endarterectomy and reconstruction are valuable adjuncts to conventional bypass surgery when attempting to revascularize "diffusely" diseased coronary arteries. One hundred forty-four consecutive patients were operated on through February 1986, all of whom required endarterectomy and reconstruction of the left anterior descending, left circumflex and right coronary arteries. There were 130 men (90%), ranging in age from 29 to 83 years (average 55.8), whose left ventricular ejection fraction ranged from 0.20 to 0.75 (average 0.54). One hundred thirty-one patients (91%) had angina preoperatively, which was Canadian Cardiovascular Society class III or IV in 85 (59%). Fifteen operations (10%) were repeat procedures. All operations were performed using intermittent ischemic arrest. There was an average of 5.0 grafts per patient (range 3 to 8), with an average of 3.8 endarterectomized vessels per patient (range 3 to 7). There were 14 surgical deaths (10%), all cardiac in origin. Statistically significant (p less than 0.01) risk factors for increased operative mortality included repeat surgery, ejection fraction less than or equal to 0.30 and age greater than or equal to 70 years. The operative mortality rate in 106 low risk patients (male gender, age less than 70 years, ejection fraction greater than 0.30, first operation) was 3.8% (4 patients). Nonfatal complications included 13 perioperative myocardial infarctions (10%). Long-term follow-up data are available for all 102 surviving patients for an average of 30 months (range 7 to 92). There were 12 late deaths 1 to 52 months postoperatively. The 5 year actuarial survival rate is 71% for the entire group and 87% for the 106 low risk patients.(ABSTRACT TRUNCATED AT 250 WORDS)
