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The Annals of Thoracic Surgery, Vol 46, 289-296, Copyright © 1988 by The Society of Thoracic Surgeons
N Shapira, FJ Lumia, JS Gottdiener, P Germon and GM Lemole
During a three-year period, complete revascularization of diffusely
diseased left anterior descending (LAD) coronary arteries was accomplished
by extensive endarterectomy in conjunction with bypass grafting in 37
patients in whom conventional bypass was not feasible. This group
constituted 7.0% of all patients undergoing nonemergency coronary
revascularization during this period. The left internal mammary artery was
used to bypass the endarterectomized LAD artery in 22 patients. There was 1
(2.7%) operative death and 1 perioperative myocardial infarction. At
follow-up, which was 100% with a mean of 41.4 months, all endarterectomy
patients were in New York Heart Association Functional Class I or II.
Twenty-four endarterectomy patients underwent first-pass radionuclide
angiographic stress testing 20 months after operation. Twenty patients
(83%) had excellent postoperative exercise tolerance, achieving 5 to 7 mets
on treadmill testing. Left ventricular functional reserve was preserved, as
evidenced by an increase of global ejection fraction from 48 +/- 15% at
rest to 59 +/- 18% (p less than 0.005) with exercise. A similar increase
was measured in the proximal and distal anterior wall segmental ejection
fractions. No difference in response to exercise was found between the
internal mammary artery and the vein graft groups. Thus, complete
revascularization of the diffusely diseased LAD artery can be accomplished
by adjunct endarterectomy without added morbidity or mortality and with
excellent functional results.
ARTICLES
Adjunct endarterectomy of the left anterior descending coronary artery
Department of Surgery, Veterans Administration Medical Center, Washington, DC.
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