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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 539-544, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Goldstein, E Cooper, A Saltups and J Boxall
Fifty-one consecutive patients underwent 68 manual core endarterectomies
between April 1985 and May 1987. There were 42 men and nine women, mean age
60 years (range 39 to 81). All patients underwent coronary bypass grafting
alone. There were no reoperations. There was one operative death (2%).
Forty patients consented to early (mean 19 days) and 27 to late (mean 19
months) repeat angiography. At the early restudy 47 of 52 (90%) grafts to
endarterectomized vessels were patent. This rate fell to 27 of 42 (64%) at
late restudy. There was considerable variation in the angiographic
appearance of the endarterectomized vessels, ranging from a large caliber,
smooth walled vessel to an attenuated vessel with irregular walls. In
general, there was a tendency toward "shrinkage" of these vessels by the
late restudy, suggesting fibrosis in the walls. We conclude that, although
endarterectomy can be done on most atheromatous vessels with excellent
early graft patency, these vessels tend to show an accelerated
deterioration with time, resulting in a low late patency rate. We suggest
that the procedure be reserved for vessels that are truly inoperable by
other means and only for vessels that supply a coronary bed of at least
moderate size.
ARTICLES
Angiographic assessment of graft patency after coronary endarterectomy
Prince Henry's Hospital, Melbourne, Australia.
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