Early and Late Results of Coronary Endarterectomy in 3,369 Patients

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

“…The right coronary artery was the first and is still the most frequently used artery because of the greater technical simplicity of the procedure in this artery and the relatively low risk. Brenowitz et al 12 introduced the use in the left arterior descending artery, but they reported a higher immediate mortality, as did others 3,11,13 . These data could not be reproduced by Minale et al 18 or by us, where a similar incidence was shown.…”

“…Livesay et al 3 have found a small increase in the risk of mortality (2.9% per year) and in late complications in the long-term. The clinical evolution and prognosis, however, were similar to those of patients undergoing only myocardial revascularization.…”

“…A first issue to be approached is the definition of the ideal patient and the concept of diffuse atherosclerotic disease of coronary arteries. Livesay et al 3 have considered necessary the presence of occluded arteries with multiple stenoses and diffuse distal involvement. 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.…”

“…When comparing conventional myocardial revascularization with that associated with coronary endarterectomy, Livesay et al 3 identified in the latter group a higher incidence of male patients, of patients with diabetes mellitus, with ventricular dysfunction, and a higher number of arteries undergoing revascularization per patient. The higher incidence of postoperative acute myocardial infarction was related to incomplete obstruction (stenosis <90%) of the coronary artery undergoing endarterectomy 13 .…”

“…The need for complete myocardial revascularization in these patients has justified the resurgence of coronary endarterectomy 2 . Because of the difficulty in defining precisely the ideal patients to undergo coronary endarterectomy, which results in a variability of indications and occasionally in its indiscriminate use, coronary endarterectomy has been characterized as a risk factor of mortality associated with myocardial revascularization 3 , mainly related to perioperative acute myocardial infarction. Therefore, the use of coronary endarterectomy is still a matter of controversy and its results are highly variable due to lack of uniformity.…”