Coronary endarterectomy revisited: mid-term angiographic results

OBJECTIVES: To evaluate the value of concomitant coronary endarterectomy (CE) in the modern era of coronary revascularization. METHODS: Retrospective study. Twenty-eight patients (five women; 23 men) who underwent coronary endarterectomy were angiographically studied 24 +/- 22 months after the procedure. Necessity CE (vessel completely occluded or with lumen less than 1 mm) was performed on the left anterior descending (LAD) artery in 12 patients, the right coronary artery (RCA) in nine, the obtuse marginal artery (OM) in five and a diagonal branch in two patients. Conduits used for revascularization were the internal thoracic artery (ITA) in 11 (all anastomosed to the LAD; combined with saphenous vein patch in four) and a saphenous vein graft in 17 patients. Mean atherosclerotic core length was 3.3 +/- 1.8 cm. An average of 3.1 +/- 0.7 distal anastomoses per patient were constructed, with mean aortic cross-clamp and cardiopulmonary bypass times of 61.2 +/- 20.2 mins and 94.0 +/- 23.5 mins, respectively. RESULTS: Overall, angiographic patency rate was 71% (20 of 28) for the endarterectomized vessels (12 of 12 LAD, six of nine RCA, two of five OM and none of two diagonal arteries) and 93% (57 of 61) for the nonendarterectomized vessels. Among the eight patients with occluded CE vessels, two sustained a perioperative myocardial infarction, five developed angina during follow-up, and one patient remained asymptomatic. CONCLUSION: Necessity CE demonstrates acceptable mid-term patency. In addition, this study showed excellent patency following CE of the LAD revascularized with the ITA, with or without only a saphenous vein patch.