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

Abstract

Objective: Early reports showed a high incidence of postoperative morbidity and mortality after coronary endarterectomy, and its value is still controversial. With technical improvement the role of coronary endarterectomy has been reviewed. In this study we evaluate our results of coronary endarterectomy, and show our strategy for patients with diffuse coronary artery disease. Method: We retrospectively reviewed 278 patients who underwent coronary artery bypass grafting, between January 2000 and December 2001, separated in two groups. The endarterectomy group-32 patients (11.5%) who underwent coronary endarterectomy and the control group of patients characteristics similar to the first group. Results: The mean follow-up time was 9.9 months. Both groups only demonstrated a statistical difference in the number of previous myocardial infarctions. The coronary endarterectomy was performed on 38 vessels, 78.75% in the left coronary system, and 21.05% in the right system. In the postoperative follow-up no significant differences were detected, but in the coronary endarterectomy group the incidence of intra-aortic balloon pump insertion was higher. Conclusions: We demonstrated that coronary endarterectomy should be used to achieve complete revascularization in patients with diffuse coronary disease, and the results are similar to conventional surgical treatment. A long-term follow up is necessary to demonstrate the future performance of these vessels and grafts.

Coronary Endarterectomy: a Case Control Study and Evaluation of Early Patency Rate of Endarterectomized Arteries

“…The establishment of a CG, like in other studies, allowed the homogenization of the sample, providing data that suggest the benefit of CE in patients with complex coronary disease with low morbidity and mortality [2,6] .…”

“…Perioperative characteristics (urgency of the surgery, CPB time, aortic clamp time, average of grafts, postoperative AMI and stroke, hospital stay time after surgery, and mortality) are listed gender is a risk factor for mortality, CE is more associated with the male gender [11] . One possible cause is the shorter length and caliber of the arteries in women [2] . CE can be programmed before arteriotomy, but it is generally an incidental procedure performed when the artery does not have conditions for an anastomosis with the graft, due to very intense atherosclerosis.…”

“…CE consists of removal of the atheromatous plaque, dissection of the vascular wall, and removal of the internal and middle layers involved in the atherosclerotic process, preserving the adventitia and restoring the lumen of the artery [2] . Therefore, CE is a surgical procedure associated with CABG surgery.…”

“…Surgeons generally prefer vessels with diameter ≥ 1.5 mm, supplying the viable myocardium [1,4] . It is performed especially when localized conditions prevent adequate distal flow [2,6] . Another situation that may require CE is the presence of a calcified or extremely hard plaque that ruptures with the suture or obstructs the flow, hindering the anastomosis [2] .…”

“…Surgical treatment is the standard procedure for patients with complex coronary artery disease (CAD), aiming at a complete myocardial revascularization [1] . In patients with diffuse CAD, characterized by long threads affected by atherosclerosis, coronary endarterectomy (CE) may be necessary, with the purpose of obtaining a complete revascularization or facilitating the anastomosis of seriously calcified arteries [2] . The factors that increase the likelihood of diffuse CAD include advanced age, prior percutaneous coronary intervention, and comorbidities, such as diabetes mellitus (DM) and dyslipidemias [3][4][5] .…”