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Ann Thorac Surg 2006;82:2342
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Cardiovascular Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021 Japan

(Email: nishi24{at}jc4.so-net.ne.jp).

To the Editor:

We thank Dr Bezon [1] for his interest in our recent article regarding coronary endarterectomy on the diffusely diseased coronary artery. As described in the article [2], the crux of our technique is to exclude the native endarterectomized coronary artery wall to the maximum extent possible and to use the internal thoracic arterial intima as the new coronary artery lumen. We introduced this technique in 1994 and believe that it decreases the risk of intimal proliferation and provides a better match in diameter with the graft, reconstructed segment, and native coronary artery, thereby resulting in better flow patterns. This principle is also adopted when performing coronary artery bypass grafting by using long arteriotomy and the on-lay patch technique without coronary endarterectomy. In addition to excluding the diseased lesion, maintaining the adequate diameter is indispensable for the coronary reconstruction of diffusely diseased coronary arteries.

We also congratulate Dr Bezon for his upgrade of recent studies published in the year 2000 [3]. These results substantiate our technique of coronary endarterectomy as an optimal method that yields a higher success rate as compared with other methods. Further assessment of these long-term results is necessary to demonstrate the superiority of this method over other methods.

The strategy we adopted for diffusely diseased coronary arteries aimed at complete revascularization for the target vessels that are difficult to anastomose by simple grafting method. Initially the plaque exclusion technique with on-lay patch anastomosis is attempted. Endarterectomy is performed only in cases wherein the target vessels possess a particularly long or severely calcified plaque. We agree with Dr Bezon’s opinion on this matter, and we believe that this aspect should always be considered when performing coronary endarterectomy.

Owing to the recent advances in catheter intervention technology, such as drug-eluting stents, the target vessels for surgical treatment will become more complicated and diffusely diseased. Although this method is, as Dr Bezon described, tedious and time-consuming, coronary endarterectomy with on-lay patch anastomosis could be a favorable option for coronary artery bypass surgery in the near future.

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1. Bezon E. Coronary artery reconstruction: optimal technique of coronary endarterectomy (letter) Ann Thorac Surg 2006;82:2341-2342.[Free Full Text]
2. Nishi H, Miyamoto S, Takanashi S, et al. Optimal method of coronary endarterectomy for diffusely diseased coronary arteries Ann Thorac Surg 2005;79:846-853.[Abstract/Free Full Text]
3. Barra JA, Bezon E, Mondine P, et al. Coronary artery reconstruction for extensive coronary disease: 108 patients and two years follow-up Ann Thorac Surg 2000;70:1541-1545.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nishi, H. Search for Related Content PubMed Articles by Nishi, H. Related Collections Coronary disease Related Article