Early and late results of combined endarterectomy and coronary bypass grafting for diffuse coronary disease.

Between October 1969 and December 1979, a total of 440 patients who had diffuse coronary artery disease were treated with combined endarterectomy and coronary bypass grafting. This constitutes 42 percent of all patients operated on at the same institution during this period. Six hundred eight endarterectomies were performed, 329 on the right coronary artery, 227 on the left anterior descending coronary artery and 52 on the left circumflex coronary artery. The early mortality rate was 4.3 percent and the late mortality rate 9 percent during a mean follow-up period of 47 months. The perioperative infarction rate was 15 percent. Ninety-five percent of survivors were asymptomatic or in improved condition. Only 11 patients were lost to follow-up study. Three hundred fourteen patients (71 percent) were reinvestigated with coronary and graft arteriography 1 month to 8 years postoperatively. The early patency rate of grafts to the endarterectomized vessels was 85 percent and the late patency rate (1 year or more) was 77 percent. The runoff was good in 79 percent, fair in 14 percent and poor in 7 percent of grafts. Endarterectomy is a valuable additional procedure in the management of patients with diffuse coronary artery disease.