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Ann Thorac Surg 1989;48:235-241
© 1989 The Society of Thoracic Surgeons

Articles

Controversial aspects of coronary endarterectomy

C. Minale, MD*, S. Nikol, MD, M. Zander, MD, R. Uebis, MD, S. Effert, MD, B.J. Messmer, MD

Department of Thoracic and Cardiovascular Surgery and Department of Internal Medicine I, University Hospital of RWTH Aachen, Aachen, West Germany

Accepted for publication February 22, 1989.

* Address conespondence to Dr Minale, Department of Thoracic and Cardiovascular Surgery, University Hospital of RWTH Aachen, Pauwelsstrasse, 5100 Aachen, West Germany.

Between 1980 and 1987, 635 patients underwent coronary bypass grafting combined with coronary endarterectomy. A total of 728 vessels were endarterectomized and grafted, There were 15 early deaths (2.3%). The mortality rate was higher (7.8%) for multiple-vessel endarterectomy (p < 0.05). The ratio of MB fraction of creatine kinasc to total creatine kinase was greater than or equal to 0.10 in 48% of the cases. The first consecutive 132 survivors were followed for an average of 16 months (range, 4 months to 5 years). No late deaths occurred. Fifty-nine unselected patients underwent postoperative recatheterization at a mean interval of 18 months. An improvement in heart Wall contractility could be detected in 13 patients (16.5%) and deterioration in 14 patients (17.7%). A more detailed analysis of wall contractility showed a higher rate of improvement in die posterior wall than in the anterior wall (p > 0.05). Furthermore, the better the contractility before operation, the greater the rate of deterioration after operation (p < 0.05). Despite an average of 55% of all endarterectomized vessels being occluded or severely restenosed, 90% of the patients were clinically improved. A multiparametric analysis revealed that the revascularization of myocardial areas that required endarterectomy had no significant influence with respect to clinical improvement. Endarterectomy should be limited, whenever possible, to myocardial areas with already impaired contractility. Endarterectomy of multiple branches should be treated with caution because the risk of deterioration is potentiated, with a significantly higher perioperative mortality rate.




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