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Coronary Endarterectomy: Postoperative Angiographic Results
1Department of Cardiology, University Hospital of Tinaztepe, Izmir, Turkey.
Insights
Coronary endarterectomy (CE) during bypass surgery shows higher graft patency rates (73.4%) compared to conventional bypass (63.7%). CE is recommended when simple anastomosis may not ensure adequate long-term patency.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease necessitates bypass grafting.
- Graft patency is crucial for long-term outcomes.
- Coronary endarterectomy (CE) is a surgical technique to improve vessel patency.
Purpose of the Study:
- To compare postoperative graft patency rates after coronary bypass surgery with and without coronary endarterectomy (CE).
- To evaluate the long-term efficacy of CE in maintaining coronary artery bypass graft patency.
Main Methods:
- A comparative descriptive study was conducted.
- Postoperative coronary angiographies were used to assess graft patency.
- Vessels with and without CE were analyzed for patency rates.
Main Results:
- Vessels undergoing CE demonstrated a significantly higher patency rate (73.4%) at an average of 47.7 months post-surgery compared to vessels without CE (63.7%).
- The right coronary artery (RCA) showed a statistically significant difference in patency rates between CE (66.6%) and non-CE (45.7%) groups.
- The left anterior descending artery (LAD) exhibited the highest patency rates in both CE and conventional bypass groups.
Conclusions:
- Coronary endarterectomy is a valuable adjunct to coronary bypass surgery when optimal anastomosis patency is uncertain.
- The primary goal of achieving full revascularization and long-term graft patency supports the judicious use of CE.
- CE can significantly improve graft patency, particularly in specific coronary arteries like the RCA.
Objective:
To compare the postoperative graft patency rates of patients who had undergone coronary endarterectomies (CE) during coronary bypass surgery to those of patients who had not had CE, based on postoperative coronary angiography.
Study Design:
Comparative descriptive study.
Place And Duration Of Study:
Coronary Angiography Unit, Tınaztepe University Faculty of Medicine, Turkey, from November 2010 through June 2021.
Methodology:
Patients who had undergone CE during coronary bypass surgery were included. Postoperative morbidity results and the patency rates of the vessels with and without endarterectomy were evaluated via coronary angiographies that had been performed.
Results:
The patency rate in vessels that underwent coronary endarterectomy was determined to be 73.4% according to coronary angiographies performed after an average of 47.7 months. The patency rate in vessels without endarterectomy was 63.7%. The highest patency rate was found in the left anterior descending artery (LAD) in both CE and conventional bypass coronary arteries and the lowest patency rate was found in the diagonal artery (D) in both CE and conventional bypass coronary arteries. In the comparison of vessels with and without CE, the patency rate was found to be 66.6% in patients with CE on the right coronary artery (RCA) and 45.7% in patients without CE on the right coronary artery and the difference was statistically significant (p<0.037).
Conclusion:
Coronary endarterectomy should be used when it is believed that a simple anastomosis would not provide adequate patency during coronary bypass surgery because the primary goal should be to achieve full revascularization and a long-term patency rate.
Key Words:
Coronary angiography, Coronary bypass grafting, Endarterectomy, Patency rate.
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