ADJUNCTIVE CORONARY ENDARTERECTOMY - IMPROVED SAFETY IN MODERN CARDIAC-SURGERY

Background. Advances in cardiac surgery have led to an improved safety record for coronary endarterectomy. Methods. We retrospectively revie wed the cases of 64 patients who underwent adjunctive coronary endarte rectomy between August 1988 and February 1992. There were 44 men, and the mean age was 65 years. Forty-one patients (64%) had sustained a pr evious 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% sten osis) 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-u p. 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 signi ficantly associated with higher long-term mortality (p < 0.02). Conclu sions. Overall, these results demonstrate that in modern cardiac surge ry, coronary endarterectomy is safer than previously thought and can b e used effectively to achieve complete revascularization in selected p atients.