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
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).