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[Endarterectomy of left coronary arteries. An angiographic follow-up study]
S M Almdahl1, J Aksnes, O Geiran
1Kirurgisk avdeling A, Rikshospitalet, Oslo.
Insights
Coronary artery endarterectomy offers acceptable outcomes for patients with diffuse distal disease, improving angina and functional status. Graft patency was lower in endarterectomized vessels compared to non-endarterectomized ones.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Context:
- Coronary artery disease (CAD) often presents with diffuse distal involvement, posing challenges for traditional revascularization.
- Endarterectomy has been explored as an alternative for complex CAD cases.
Purpose:
- To evaluate the safety and efficacy of coronary artery endarterectomy for patients with diffuse distal coronary artery disease.
Summary:
- 25 patients underwent left coronary artery endarterectomy (8 with concurrent right artery procedure). Operative mortality was 4% (1/25), with 8% non-fatal perioperative infarction.
- Follow-up (avg. 27 months) showed 74% angina-free, improved New York Heart Association (NYHA) class in all patients.
- Graft patency was 74% for endarterectomized vessels versus 91% for non-endarterectomized arteries.
Impact:
- Coronary artery endarterectomy provides acceptable angiographic and functional results for patients with diffuse distal CAD, potentially offering a treatment option for previously inoperable cases.
- The study highlights the need to consider endarterectomy for complex CAD, despite lower graft patency in treated vessels.
Abstract:
From January 1989 to December 1993, 25 patients underwent endarterectomy on the left coronary artery system. Eight of the patients had concurrent endarterectomy of the right coronary artery. The operative mortality consisted of one high-risk patient who died from an intraoperative myocardial infarction. Two patients developed non-fatal perioperative infarction. The follow-up period averaged 27 months (range 4-58 months). At follow-up one patient was lost for evaluation owing to unexpected sudden death, no patients had experienced myocardial infarction, 17 patients (74%) were free of angina, two patients were in NYHA class I and four in NYHA class II. All patients showed an improvement in relation to their preoperative condition. Two asymptomatic patients refused recatheterization, while 21 patients had a control angiographic study. 25 of 34 grafts to endarterectomized vessels were open (patency 74%) compared with 41 of 45 grafts to non-endarterectomized arteries (patency 91%). We find the angiographic and functional results acceptable and they should be acknowledged with reference to patients with diffuse distal coronary artery disease, many of whom would otherwise be considered inoperable.