Bypass grafting with coronary endarterectomy: immediate and long-term results.
BACKGROUND
Increased morbidity and mortality have been associated with coronary artery bypass grafting when an adjunctive coronary endarterectomy is performed. In this study we retrospectively reviewed our experience with coronary bypass and endarterectomy to evaluate the early and late outcome and to determine the independent predictors of early mortality and morbidity of this procedure.


METHODS
Between May 1989 and December 2000, 107 patients underwent myocardial revascularization with coronary endarterectomy to achieve a complete revascularization. There were 90 men and 17 women; the mean age was 64 +/- 8.1 years. Sixty-three (58.9%) patients had a previous myocardial infarction, and 29 (27.1%) were operated on on an emergency basis. An ejection fraction of less than 30% was present in 9 (8.4%) patients. The most frequently endarterectomized vessel was the left coronary artery (74.8%). Follow-up information was obtained from 97 patients (100% of the long-term survivors).


RESULTS
There were 5 (4.7%) early deaths. The 72-month survival was 91.2% +/- 4.9%. Seventy-seven (83.7%) of the survivors were symptom free, and 15 (16.3%) were in Canadian Cardiovascular Society class II to III. An improvement of the ejection fraction after the operation was shown in the 97 patients who underwent echocardiographic control (P =.03) and angiography. The 30.4-month patency rate of the endarteriectomized coronary arteries was 72% +/- 11%.


CONCLUSIONS
Coronary endarterectomy is a safe and effective procedure for achieving a complete revascularization in patients with end-stage coronary disease.
Departments of Cardiovascular Surgery and Cardiology, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
Giuseppe
G
Marinelli
Bruno
B
Chiappini
Marco
M
Di Eusanio
Roberto
R
Di Bartolomeo
Ilaria
I
Caldarera
Cinzia
C
Marrozzini
Antonio
A
Marzocchi
Angelo
A
Pierangeli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency / Q000502:physiology