Results of Adjunctive Coronary Endarterectomy in 548 Patients
DOI:
https://doi.org/10.1532/HSF98.20071058Abstract
Coronary endarterectomy is a controversial procedure that plays a particular role in the treatment of coronary artery disease. We retrospectively investigated the results for 548 patients who underwent coronary endarterectomy as an adjunctive therapy for coronary artery bypass graft surgery during the period between 1996 and 2004. We assessed short-term outcomes and identified risk factors for adverse outcomes. Mean patient age was 67.9 + 9.3 years and mean angina class was 2.7 + 0.3. The mean number of distal anastomoses was 3.8 + 1.1 patients (73.4%) had single and 151 (27.6%) multiple coronary artery endarterectomies. Of the 151 patients who underwent multiple endarterectomies, 97 (17.7%) had endarterectomies in 2 coronary arteries, 40 (7.2%) in 3 coronary arteries, 11 (2%) in 4 coronary arteries, 2 (0.36%) in 5 coronary arteries, and 1 (0.18%) in 6 coronary arteries. Postoperative mortality was 6.2% (34 patients). The predictors for early mortality were recent myocardial infarction and left ventricular dysfunction. Our results suggest that adjunctive coronary endarterectomy can be accomplished with acceptable results but with higher mortality rates than ordinary coronary artery bypass grafting. Adjunctive coronary endarterectomy should be considered as a last option for the surgical treatment of diffuse coronary disease.References
Bailey CP, May A, Lemmon WM. 1957. Survival after coronary endarterectomy in man. J Am Med Assoc 164(6):641-6.nBedi HS, Kalkat MS. 2000. Endarterectomy on a beating heart: comment on: Ann Thorac Surg 1999; 68(2):630-1. Ann Thorc Surg 70(1):338-40nBrenowitz JB, Kayser KL, Johnson WD. 1988. Results of coronary endarterectomy and reconstruction. J Thorac Cardiovasc Surg 95(1):1-10.nBrenowitz JB, Johnson WD, Kayser KL, Saedi SF, Dorros G, Schley L. 1998. Coronary artery bypass grafting for the third time or more: results of 150 consecutive cases. Circulation 78(3 Pt 2):1166-70.nEpps WM, Francalancia N. 2002. Transmyocardial laser revasacularization (TNR) and its role in the treatment of patients with coronary artery disease and angina. Curr Surg 59(3):253-7.nFerraris VA, Harrah JD, Moritz DM, Stritz D, Ferraris SP. 1999. Long-term angiographic results of coronary endarterectomy for the treatment of diffuse coronary arte disease. Ann Thorac Surg 68(4):1272-7.nFukui T, Takanashi SI, Hosoda Y. 2005. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg 80(6):2098-105.nGowdak LH, Schettert IT, Rochitte CE, et al. 2005. Cell therapy plus transmyocardial laser revascularization for refractory angina. Ann Thorac Surg 80(2):712-4.nKlein HM, Ghodsizad A, Borowski A, et al. 2004. Autologous bone marrow-derived stem cell therapy in combination with TMLR. A novel therapeutic option for end stage coronary heart disease: report on 2 cases. Heart Surg Forum 7(5):E416-9.nMills NL. 1998. Coronary endarterectomy: surgical techniques for patients with extensive distal atherosclerotic coronary disease. Adv Card Surg 10:197-227.nNaseri E, Arsan S. 1999. Coronary endarterectomy on beating heart [Letter]. Ann Thorac Surg 68(2):630-1.nNishi H, Miyamato S, Takanashi S, et al. 2005. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries. Ann Thorac Surg 79(3):846-52; discussion 852-3.nOelert H, Hake U, Schmiedt W, Iversen S, 1988. Prerequisite coronary endarterectomy for coronary bypass gafting. Adv Cardiol 36:62-4.nO'Neil-Callahan K, Katsimaglis G, Tepper MR, et al. 2005. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol 45(3):336-42.nSantini F, Casali G, Lusini M, et al. 2002. Mid-term results after extensive vein patch reconstruction and internal mammary artery grafting of the diffusely diseased left anterior descending coronary artery. Eur J Cardiothorac Surg 21(6): 1020-5.nScheld HH, Gorlach G, Evers J, Moosdorf R, Hehrlein FW, Walter PJ. 1988. Use of endarterectomy as an adjunct to coronary artery bypass. Adv Cardiol 36:65-70.nSirivella S, Gielchinsky I, Parsonnet V. 2005. Results of coronary endarterctomy and coronary bypass grafting for diffuse coronary artery disease. Ann Thorac Surg 80:1738-45.nSundt TM 3rd, Camillo CJ, Mendeloff EN, Barner HB, Gay WA Jr. 1999. Reappraisal of coronary endarterectomy fot the treatment of diffuse coronary artery disease. Ann Thorac Surg 68(4):1272-7nTiruvoipati R, Loubani M, Lencioni M, Ghish S, Jones PW, Patel RL. 2005. Coronary endarterectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg 79(6):2999-3003.nTiruvoipati R, Loubani M, Peek G. 2005. Coronary endarterectomy in the current era. Curr Opin Cardiol 20(6):517-20.n
