Coronary Endarterectomy. Part 1 (Preliminary Results)

pp 747-752

Abstract

Background

The increase in the number of patients with diffuse coronary disease and poor distal portion of vessels aims to a therapeutic challenge. The success of an intervention is in function of reaching a complete revascularization of viable myocardium, a situation that requires sometimes the use of complex procedures, with multiple grafts and coronary endarterectomies poses that challenge.

Outcomes

To identify the actual value of coronary endarterectomy, considering: 1) Percentage use of this approach.2)Postoperative morbidity and 3) Perioperative mortality.

Methods

All coronary surgeries performed between 01/01/97 to 30/04/98 were prospectively and consecutively included. Combined procedures were excluded.A p value less than 0.05 was considered significant.

Results

169 patients were included, 47 of them had coronary endarterectomy (27.8%). In this group the statistically significant perioperative variables were smoking (53.2% against 40.3%, p=0.04), previous myocardial infarction (29.79% against 10.09% p=0.006) and severe ventricular disfunction (31.9% against 17.2%, p = 0.03). There were 10 deaths, 3 in the endarterectomy group (6,3%) and 7 in the rest (5.7%, p = NS). There were no significant differences either in the duration of the surgery (122.4 minutes against 119.4-ECC time; 80.16 versus 75.58 minutes-clamp time) or in the postoperative complications; perioperative infarction (4.2% against4.0%), use of intra aortic balloon (12.7% versus10.09%), arrhythmias (17.02% versus 14.68%), conduction disturbances (6.3% versus 4.5%) and renal insufficiency (4.26% versus 7.34%).

Conclusions

1)More than a fourth of the coronary revascularized population required endarterectomy (27.8%). 2) Endarterectomy resulted safe neither affecting perioperative morbility or mortality, nor prolong-ing surgery time. 3) This procedure aims as a therapeutic option in patients with diffuse coronary dis-ease and poor quality distal vessels, not suitable for other surgical approach.