Técnica e resultados da endarterectomia de artéria coronária

Coronary endarterectomy: technique and results in a case-control study

“…From this we conclude that this percentage could be higher, if the same principles to treat the right coronary artery were utilized or considering only the left coronary branches. The same reasoning can be applied to the multiple endarterectomies, which vary for department to department from 5.5% published by Salerno et al [11], to 63.9% as presented by Gill et al [18]. In this study the rate was 15.62% of the cases.…”

“…As can be seen in Table 4, the incidence of ECA varies between the different cardiovascular surgery departments -from 1% to 50%, depending on the experience and the interest of the department. In Brazil, in 1994, Salerno et al [11] divulged their experience and 3.9% of their grafted patients were also endarterectomized, with an average age of 58.9 years and a predominance of men (90%). As is also demonstrated in Table 4, the most common artery to be submitted to ECA is the right coronary.…”

Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

“…In patients undergoing multiple coronary endarterectomy and in the presence of 2 or more of these factors, the index was 26.9%, and in those with no risk factor it was 1.7%. The application of this index was reproduced by Salerno et al 8 , but not by other authors 14 . Therefore, determination of the risk factors related to mortality of myocardial revascularization associated with coronary endarterectomy is extremely important to establish the most favorable cases.…”

“…Christakis et al 7 have added the presence of arteries perfusing viable myocardium with reversible ischemia, documented by scintigraphy with thallium or analysis of regional contraction on echocardiogram, or both. The contraindications for the procedure consisted of arteries with diameter smaller than 1mm irrigating myocardial areas of fibrosis secondary to previous infarcts and extremely calcified vessels 8,9 . Souza et al 10 divide the indications of coronary endarterectomies into planned, when the procedure may be planned through preoperative coronary angiography, and necessary, when during operation the surgeon finds a previously attractive artery for myocardial revascularization but only coronary endarterectomy makes the procedure feasible.…”

“…Most studies, however, show a higher incidence of acute myocardial infarction, immediate mortality 8 , and a lower patency of the grafts performed in arteries undergoing endarterectomy, in relation to those where this resource was not used. The study by Livesay et al 3 has analyzed the early and late evolution of 3,369 patients undergoing coronary endarterectomy, as compared with another group of 27,095 patients, in whom myocardial revascularization was not associated with coronary endarterectomy, during a period of 14 years.…”