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Ann Thorac Surg 1995;60:1749-1754
© 1995 The Society of Thoracic Surgeons
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
Accepted for publication August 5, 1995.
* Address reprint requests to Dr Shumway, University of Minnesota, Box 207 UMHC, 420 Delaware St SE, Minneapolis, MN 55455.
Background.: Advances in cardiac surgery have led to an improved safety record for coronary endarterectomy.
Methods.: We retrospectively reviewed the cases of 64 patients who underwent adjunctive coronary endarterectomy between August 1988 and February 1992. There were 44 men, and the mean age was 65 years. Forty-one patients (64%) had sustained a previous infarction. Overall, endarterectomy was performed on 76 vessels, and the right coronary system was involved in 46 (61%).
Results.: The postoperative infarction rate was 5%. Incomplete occlusion (<90% stenosis) of the endarterectomized vessel significantly increased the risk of infarction (p < 0.05). There were two early deaths (3%). The mean follow-up was 46 months. Clinically, 91% of the survivors were angina free, and 80% had no symptoms and heart failure at the time of follow-up. Left ventricular function had improved in 36% of those restudied (5/14). A total of 17 recatheterizations were done at a mean interval of 19 months after operation. The endarterectomy graft patency rate was 80% (16/20) compared with 78% (28/36) for conventional grafts (p = not significant). The actuarial survival rates were 89% and 71% at 1 year and 5 years, respectively. A history of previous infarction was significantly associated with higher long-term mortality (p < 0.02).
Conclusions.: Overall, these results demonstrate that in modern cardiac surgry, coronary endarterectomy is safer than previously thought and can be used effectively to achieve complete revascularization in selected patients.
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