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[Coronary endarterectomy (blind and open) associated with bypass. Experience in 143 patients]
L Beretta1, P Fundarò, C Santoli
1Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale L. Sacco, Milano.
Insights
Coronary endarterectomy (EA) with bypass is a valuable surgical option for complex coronary artery disease. This study shows EA offers significant symptom relief and improved outcomes for patients with otherwise inoperable arteries.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery disease (CAD) poses significant challenges, particularly in cases involving diffuse or complex lesions.
- Surgical revascularization techniques are crucial for managing severe CAD.
- Coronary endarterectomy (EA) offers an alternative to bypass grafting in specific scenarios.
Purpose of the Study:
- To evaluate the efficacy and outcomes of coronary endarterectomy (EA) combined with bypass grafting.
- To compare conventional EA with open EA techniques.
- To assess the early and late results of EA in a patient cohort.
Main Methods:
- A retrospective analysis of 173 coronary endarterectomies (EA) with bypass performed between June 1982 and January 1986.
- Categorization of EA into conventional (130 cases) and open EA with coronary reconstruction (43 cases).
- Utilization of internal mammary artery (IMA) for revascularization in 9 open EA cases.
Main Results:
- The overall early mortality rate was 3.5% (2.0% for conventional EA, 7.3% for open EA).
- Perioperative myocardial infarction occurred in 8.4% of patients (7.8% conventional EA, 9.7% open EA).
- At a mean follow-up of 18.4 months, 89.8% of survivors were symptom-free or significantly improved.
Conclusions:
- Coronary endarterectomy (EA) is a beneficial procedure for managing complex coronary artery disease.
- EA provides a viable surgical option for patients with otherwise inoperable coronary arteries.
- The study demonstrates favorable long-term outcomes and symptom improvement following EA.
Abstract:
From June 1982 until January 1986, 173 coronary endarterectomies (EA) with bypass were performed in 143 patients. The series includes 130 conventional EA and 43 open EA with coronary reconstruction. In 9 cases of open EA the revascularization of the reconstructed coronaries was accomplished with internal mammary artery (AMI). 70 (40.4%) EA were performed on the right coronary artery, 75 (43.3%) on the left anterior descending coronary artery and 28 (20.1%) on the left circumflex coronary artery. The early mortality rate in the entire group was 3.5% (respectively 2.0% for the conventional EA and 7.3% for the open EA) and the rate of perioperative myocardial infarction was 8.4% (7.8% in patients receiving conventional EA and 9.7% in those receiving open EA). With mean follow-up of 18.4 months, most (89.8%) of the surviving patients were either symptoms-free or greatly improved. Coronary endarterectomy is a worth-while procedure and it allows surgical management of otherwise inoperables arteries.