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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 1-10, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JB Brenowitz, KL Kayser and WD Johnson
Since 1978, 5005 patients have had coronary artery bypass operations: 50%
had conventional grafts only (group A), 25.1% required one coronary artery
endarterectomy (group B), and 24.9% required multiple endarterectomies
(group C). Operative mortality and long-term survival were stratified
within each group according to the presence of additional risk factors:
severe left ventricular dysfunction, repeat operation, insulin-dependent
diabetes mellitus, female sex, and age over 70 years. Operative mortality
was 4.0% in group A patients, 6.3% in group B, and 10.4% in group C; it
increased in each group as the number of risk factors increased. Mortality
was higher in patients with a left coronary artery endarterectomy compared
to those with a right coronary endarterectomy only when multiple risk
factors were present. Perioperative myocardial infarction occurred in 5.6%
of group A patients, 6.5% of group B, and 13.1% of group C patients. Early
graft patency (940 patients, 18.8%) was 801 of 901 (88.9%) for
endarterectomy grafts and 2939 of 3248 (90.5%) for conventional grafts.
Late patency (over 1 year) in 288 symptomatic patients was 137 of 191
(71.1%) for endarterectomy grafts and 644 of 850 (75.8%) for conventional
vein grafts. Long-term (5-year) actuarial survival rate was reduced in
patients requiring endarterectomy. Current anginal status is available for
3011 of 3305 patients (91.1%): 28.9% of group A patients, 32.5% of group B,
and 33.7% of group C patients have recurrent angina at an average follow-up
of 58.3 months. The results of this study show increased operative
mortality and morbidity in patients requiring coronary artery
endarterectomy and reconstruction. However, the early results and
particularly the late survival, clinical status, and continued graft
patency justify this approach in patients with diffuse coronary artery
disease, many of whom would otherwise be inoperable.
ARTICLES
Results of coronary artery endarterectomy and reconstruction
Milwaukee Heart Surgery Associates, Wis.
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