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DOI: 10.1055/s-2007-967392
Early results of coronary artery bypass grafting with coronary endarterectomy for diffuse coronary artery disease
Purpose: In this study we analyzed early results of coronary artery bypass grafting (CABG) with additional coronary endarterectomy (CE) in patients with endstage coronary artery disease with respect to mortality, functional capacity (NYHA) & angina (CCS).
Methods: Between 8/2001 and 3/2005, 100 patients (88 m, 12 w; 65.5±9 years) with diffuse coronary artery disease (3-vessel-disease (vd): 95%, 2-vd: 3%, 1-vd: 2%) underwent CABG (4±0.9 vessels bypassed; internal thoracic artery use in 98%) with adjunctive CE on a total of 114 vessels (single-CE: 88; double-CE: 10; triple-CE: 2). Closed technique was used in 20%, open technique in 76% and in 4% a combination of both. CE was performed on RCA (n=54), LAD (n=36), RD (n=17), RCX (n=7). Cardio-pulmonary bypass time was 192±56 minutes and aortic cross clamp time was 119±31 minutes.
Results: Despite severity of endstage atherosclerosis hospital mortality was 5% (n=5). During follow-up (24.54±13.44 months), 8 patients died (cardiac failure: 3; stroke: 1; cancer: 1; unknown reasons: 3). All deaths, except one, were male patients. Duration of intensive care unit stay was 5±7 days, total hospital stay was 15±13 days. NYHA-classification clearly improved after CABG with CE from 2.2±0.95 preoperative to 1.69±0.92 postoperative. CCS also changed significantly from 2.42±0.98 to 1.48±0.77.
Conclusions: Early results of coronary endarterectomy are acceptable with respect to mortality, NYHA & CCS. This technique offers a valuable surgical option for patients with endstage coronary artery disease in whom complete revascularization otherwise can not be obtained. Continuous follow-up will be necessary to assure long-term benefit of the procedure.