CORONARY ENDARTERECTOMY REVISITED - MIDTERM ANGIOGRAPHIC RESULTS

OBJECTIVES: To evaluate the value of concomitant coronary endarterecto my (CE) in the modern era of coronary revascularization. METHODS: Retr ospective study. Twenty-eight patients (five women; 23 men) who underw ent coronary endarterectomy were angiographically studied 24+/-22 mont hs after the procedure. Necessity CE (vessel completely occluded or wi th lumen less than 1 mm) was performed on the left anterior descending (LAD) artery in 12 patients, the right coronary artery (RCA) in nine, the obtuse marginal artery (OM) in five and a diagonal branch in two patients. Conduits used for revascularization were the internal thorac ic artery (ITA) in 11 (all anastomosed to the LAD; combined with saphe nous vein patch in four) and a saphenous vein graft in 17 patients. Me an atherosclerotic core length was 3.3+/-1.8 cm. An average of 3.1+/-0 .1 distal anastomoses per patient were constructed, with mean aortic c ross-cramp and cardiopulmonary bypass times of 61.2+/-20.2 mins and 94 .0+23.5 mins, respectively. RESULTS: Overall, angiographic patency rat e was 71% (20 of 28) for the endarterectomized vessels (12 of 12 LAD, six of nine RCA, two of five OM and none of two diagonal arteries) and 93% (57 of 61) for the nonendarterectomized vessels. Among the eight patients with occluded CE vessels, two sustained a perioperative myoca rdial infarction, five developed angina during follow-up, and one pati ent remained asymptomatic. CONCLUSION: Necessity CE demonstrates accep table midterm patency. In addition, this study showed excellent patenc y following CE of the LAD revascularized with the ITA, with or without only a saphenous vein patch.