A R Djalilian1, S J Shumway. 1. Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, USA.
Abstract
BACKGROUND: Advances in cardiac surgery have led to an improved safety record for coronary endarterectomy. METHODS: We retrospectively reviewed the cases of 64 patients who underwent adjunctive coronary endarterectomy between August 1988 and February 1992. There were 44 men, and the mean age was 65 years. Forty-one patients (64%) had sustained a previous infarction. Overall, endarterectomy was performed on 76 vessels, and the right coronary system was involved in 46 (61%). RESULTS: The postoperative infarction rate was 5%. Incomplete occlusion ( < 90% stenosis) of the endarterectomized vessel significantly increased the risk of infarction (p < 0.05). There were two early deaths (3%). The mean follow-up was 46 months. Clinically, 91% of the survivors were angina free, and 80% had no symptoms of heart failure at the time of follow-up. Left ventricular function had improved in 36% of those restudied (5/14). A total of 17 recatheterizations were done at a mean interval of 19 months after operation. The endarterectomy graft patency rate was 80% (16/20) compared with 78% (28/36) for conventional grafts ( p = not significant). The actuarial survival rates were 89% and 71% at 1 year and 5 years, respectively. A history of previous infarction was significantly associated with higher long-term mortality (p < 0.02). CONCLUSIONS: Overall, these results demonstrate that in modern cardiac surgery, coronary endarterectomy is safer than previously thought and can be used effectively to achieve complete revascularization in selected patients.
BACKGROUND: Advances in cardiac surgery have led to an improved safety record for coronary endarterectomy. METHODS: We retrospectively reviewed the cases of 64 patients who underwent adjunctive coronary endarterectomy between August 1988 and February 1992. There were 44 men, and the mean age was 65 years. Forty-one patients (64%) had sustained a previous infarction. Overall, endarterectomy was performed on 76 vessels, and the right coronary system was involved in 46 (61%). RESULTS: The postoperative infarction rate was 5%. Incomplete occlusion ( < 90% stenosis) of the endarterectomized vessel significantly increased the risk of infarction (p < 0.05). There were two early deaths (3%). The mean follow-up was 46 months. Clinically, 91% of the survivors were angina free, and 80% had no symptoms of heart failure at the time of follow-up. Left ventricular function had improved in 36% of those restudied (5/14). A total of 17 recatheterizations were done at a mean interval of 19 months after operation. The endarterectomy graft patency rate was 80% (16/20) compared with 78% (28/36) for conventional grafts ( p = not significant). The actuarial survival rates were 89% and 71% at 1 year and 5 years, respectively. A history of previous infarction was significantly associated with higher long-term mortality (p < 0.02). CONCLUSIONS: Overall, these results demonstrate that in modern cardiac surgery, coronary endarterectomy is safer than previously thought and can be used effectively to achieve complete revascularization in selected patients.
Authors: Damien J LaPar; Farshad Anvari; James N Irvine; John A Kern; Brian R Swenson; Irving L Kron; Gorav Ailawadi Journal: J Card Surg Date: 2011-04-07 Impact factor: 1.620
Authors: Jan D Schmitto; Philipp Kolat; Philipp Ortmann; Aron F Popov; Kasim O Coskun; Martin Friedrich; Samuel Sossalla; Karl Toischer; Suyog A Mokashi; Theodor Tirilomis; Mersa M Baryalei; Friedrich A Schoendube Journal: J Cardiothorac Surg Date: 2009-09-22 Impact factor: 1.637
Authors: Wojciech Domaradzki; Krzysztof Sanetra; Jolanta Krauze; Leszek Kinasz; Justyna Jankowska-Sanetra; Małgorzata Świątkiewicz; Krzysztof Paradowski; Marek Cisowski Journal: Kardiochir Torakochirurgia Pol Date: 2015-12-30