Surgical revascularisation for diffuse CAD--an experience in 116 cases.
There were 94 male and 22 female, age ranges 32 to 71 years with a mean age of 54 years. All of them had angina pectoris and strong positive stress test inspite of maximum medical treatment. All had severe triple vessel disease including (12 (10%) had critical left main stem lesion, 68 (52%) were diabetic and hypertensive, 51 (44%) had myocardial infarct with 16 (14%) of them showing global hypokinesia of ejection fraction 30%. The average grafts per patient was 3.8 Seventy-nine patients (68%) and RCA endarterectomy; 19 (16%) had right and left coronary endarterectomy and 18 (15%) had left coronary artery endarterectomy. One-hundred and three (86%) were reconstructed with saphenous vein graft. 13 (12%) with IMA grafts. There was no operative mortality. Two hospital deaths and two late deaths occurred in those patients who had very poor left ventricular function. The perioperative infarct rate was 2.7%. All patients were followed-up regularly at 2 weeks, 3 months, 6 months, postoperatively. The mean follow-up was 18 months ranging 10 to 43 months. Clinically over 95% are free from angina pectoris with improved effort tolerance. We conclude that endarterectomy with patch angioplasty is an effective and safe procedure in treating Diffuse Coronary Artery Disease which cannot be treated by bypass alone. The incidence of Diffuse Coronary Artery Disease is likely to increase in the future as the percutaneous balloon angioplasty is becoming more widely practised and Re-do CABG patient would come to surgery at a more advanced state of the disease.
Tong
M C
MC
Department of Cardiothoracic Surgery, Singapore General Hospital.
Siva
C
C
Wong
J
J
Dilip
D
D
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000473:pathology / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged