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Ann Thorac Surg 2006;82:2341-2342
© 2006 The Society of Thoracic Surgeons
Department of Thoracic and Cardiovascular Surgery, University Hospital La Cavale Blanche, Brest, 29609 France
(Email: eric.bezon{at}chu-brest.fr).
The study by Nishi and colleagues [1] reports good clinical and angiographic results after coronary reconstruction associated with coronary endarterectomy.
We reported in the year 2000, postoperative angiographic results of a new technique of coronary artery reconstruction at 2 years [2, 3]. The diffusely diseased coronary artery is opened along the atheromatous lesions and is then reconstructed with an onlay patch of internal thoracic artery. The crux of this technique is exclusion of atheromatous plaques outside the lumen of the reconstructed vessel. In this way 75% of the native coronary wall is excluded. When endarterectomy is associated with coronary arterial reconstruction, 75% of the endarterectomized wall is excluded outside the lumen of the vessel. Nishi and colleagues’ [1] article is interesting. The authors confirm that the onlay internal thoracic artery patch technique and exclusion of 75% of the endarterectomized arterial wall is an improvement in coronary artery endarterectomy. We are now evaluating long-term results of a series of 235 patients who underwent coronary artery reconstruction. Among these patients, there were 50 coronary endarterectomies longer than 4 cm. The overall results are that 91% of patients are angina free and 94% of internal thoracic arteries show good patency at 2 years [2]. At 5 years, 90% of patients are angina free, 6% had cardiac-related deaths, and 3% had a myocardial infarction in the coronary artery reconstruction area. Coronary artery reconstructions with exclusion of plaques or associated with endarterectomy when plaques are too calcified or stiff produce good stable results in the long run.
The indications for coronary endarterectomy as stated by Nishi and colleagues [1] are an important concern. Likewise we consider that coronary endarterectomy should be reserved for arteries that are truly inoperable by other procedures including exclusion of plaques out of the lumen of a new reconstructed coronary vessel using our coronary artery reconstruction technique. In our practice only heavily calcified and extensive plaques are endarterectomized, whereas the others plaques are excluded [2, 3]. Nowadays coronary artery reconstruction constitutes 30% of our coronary artery practices in surgical patients younger than 75 years of age. Drastic improvements in the results of percutaneous coronary stenting have modified the profile of surgical patients and the place of coronary reconstruction with or without endarterectomy will increase in the near future. I would like to congratulate again Nishi and colleagues [1] and his surgical team for their series because this surgery is difficult, tedious, and time consuming.
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  A. D Prabhu, I. E Thazhkuni, S. Rajendran, R. A Thamaran, K. A Vellachamy, and M. P Vettath Mammary Artery Patch Reconstruction of Left Anterior Descending Coronary Artery Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 313 - 317. [Abstract] [Full Text] [PDF]
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 H. Nishi Reply Ann. Thorac. Surg., December 1, 2006; 82(6): 2342 - 2342. [Full Text] [PDF]
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