title: Optimal method of coronary endarterectomy for diffusely diseased coronary arteries.
abstract: BACKGROUND
  Although several techniques for coronary artery bypass grafting have been introduced that incorporate coronary endarterectomy (CE), there is little information about late patency among the various CE methods. To clarify the quality of CE, we assessed clinical and angiographic results of our experience with this procedure on 127 patients who had diffusely diseased coronary arteries.
  
  
  METHODS
  Between January 1994 and December 2002, 127 patients underwent coronary artery bypass grafting with CE. Sixty-eight patients undergoing CE with long arteriotomies and on-lay patch bypass grafting (group O) were compared with 59 patients undergoing CE with the conventional pull-out method (group P).
  
  
  RESULTS
  Thirty-day mortality was 2.9% in group O and 6.8% in group P. The early angiographic results of 115 patients revealed a patency rate of 92.1% (grade A: 79.4%) in group O and 88.6% (grade A: 68.6%) in group P. Actuarial survival at 5 years was 90.7% in group O and 74.0% in group P (p = 0.1). Angiograms performed on 78 patients after a mean period of 21 +/- 16 months showed a patency rate of 89.1% (grade A:76.1%) in group O and 81.0% (grade A: 38.1%) in group P (grade A: p < 0.001).
  
  
  CONCLUSIONS
  The midterm angiographic results of CE with long arteriotomies and on-lay patch bypass grafting were better than the results obtained with the conventional pull-out method. This procedure was found to be safe and effective for complete revascularization in patients with a severely and diffusely diseased coronary artery.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan. nishi24@jc4.so-net.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Minamimura
authors.forename: Takumi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged