Original Article
Outcome of coronary endarterectomy: a case-control study

https://doi.org/10.1016/S0003-4975(99)00094-6Get rights and content

Abstract

Background. Despite early reports showing a high incidence of postoperative morbidity and mortality, coronary endarterectomy continues to be used as an adjunct to coronary artery bypass grafting, particularly in diffusely diseased coronary arteries. The changing nature of patients and improvements in modern cardiac surgery call for a reevaluation of the role of coronary endarterectomy.

Methods. Data from the 56 patients, who underwent coronary endarterectomy in our institution between January 1993 and August 1996, were reviewed retrospectively and compared with a control group of 56 patients matched for age, sex, LV function, and angina class. In the endarterectomy group, there were 47 men and nine women, with a mean age of 59.6 years. The mean follow-up time was 21 months. Indications for operation were angina in 45 (80.3%), angina with signs or symptoms of cardiac failure in 3 (5.4%), and prognosis in 8 (14.3%) asymptomatic patients.

Results. Fifty (89%) patients had one, four (7.2%) had two, and 2 (3.6%) patients had three coronary arteries endarterectomized. Of these 64 endarterectomies, 33 (51.5%) involved the right coronary artery, 20 (31.3%) the left anterior descending artery, and 11 (17.2%) branches of the circumflex artery. There were three (5.4%) nonfatal myocardial infarctions in the endarterectomy group, but none in the control group (p > 0.05). Two patients (3.6%) in the endarterectomy group, but none in the control group, died within the first 30 days (p > 0.05). Actuarial survival and incidence of recurrent angina were similar in the two groups.

Conclusions. In current cardiac surgical practice, coronary endarterectomy displays satisfactory rates of postoperative morbidity and medium term results in selected groups of patients.

Section snippets

The study group

Between January 1993 and August 1996, 1366 patients underwent isolated primary CABG in our institution. Of these, 56 (4.1%) patients required at least one coronary endarterectomy. In view of the previous literature reports, we are conservative about the indications for coronary endarterectomy in our institution. It is only performed on occluded or nearly occluded vessels that have long, multiple stenoses that extend distally. In the absence of widely accepted preoperative criteria, the decision

Results

The number of grafts in the two groups is shown in Table 2. Fifty (89%) patients had one, 4 (7.2%) patients had two, and 2 (3.6%) patients had three coronary arteries endarterectomized. Of these 64 endarterectomies, 33 (51.5%) involved the right coronary artery (RCA), 20 (31.3%) the left anterior descending (LAD) artery, and 11 (17.2%) the major obtuse marginal branch of the circumflex artery.

Comment

The rationale for performing coronary endarterectomy is to undertake as complete a revascularization as possible in coronary arteries with diffuse flow-limiting atherosclerotic stenoses [6]. Early reports of a high incidence of postoperative morbidity and mortality 2, 3, 4, 5 and the introduction of alternative coronary interventional procedures such as angioplasty, stenting, and atherectomy [10] are potential explanations for the fact that endarterectomy is currently performed more

References (19)

There are more references available in the full text version of this article.

Cited by (47)

  • Coronary endarterectomy: New flavors from old recipes

    2014, Journal of Cardiology
    Citation Excerpt :

    But is coronary endarterectomy a safe procedure? Overall, hospital mortality rate ranges from 2.0% to 6.5% in international literature [16,19–21,25,29,30,38–40]. However, the mortality after CABG along with endarterectomy appears to be higher compared to that after conventional CABG because of the associated comorbidities and risk factors rather than the endarterectomy itself [1].

View all citing articles on Scopus
View full text