TY - JOUR
T1 - Adjunctive coronary endarterectomy
T2 - Improved safety in modern cardiac surgery
AU - Djalilian, Ali R.
AU - Shumway, Sara J.
PY - 1995/12
Y1 - 1995/12
N2 - 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 and 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 surgry, coronary endarterectomy is safer than previously thought and can be used effectively to achieve complete revascularization in selected patients.
AB - 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 and 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 surgry, coronary endarterectomy is safer than previously thought and can be used effectively to achieve complete revascularization in selected patients.
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U2 - 10.1016/0003-4975(95)00810-1
DO - 10.1016/0003-4975(95)00810-1
M3 - Article
C2 - 8787475
AN - SCOPUS:0029553975
SN - 0003-4975
VL - 60
SP - 1749
EP - 1754
JO - The Annals of thoracic surgery
JF - The Annals of thoracic surgery
IS - 6
ER -