Triple vessel coronary artery endarterectomy and reconstruction: Results in 144 patients

Coronary artery endarterectomy and reconstruction are valuable adjuncts to conventional bypass surgery when attempting to revascularize “diffusely” diseased coronary arteries. One hundred forty-four consecutive patients were operated on through February 1986, all of whom required endarterectomy and reconstruction of the left anterior descending, left circumflex and right coronary arteries. There were 130 men (90%), ranging in age from 29 to 83 years (average 55.8), whose left ventricular ejection fraction ranged from 0.20 to 0.75 (average 0.54). One hundred thirty-one patients (91%) had angina preoperatively, which was Canadian Cardiovascular Society class III or IV in 85 (59%). Fifteen operations (10%) were repeat procedures. All operations were performed using intermittent ischemic arrest. There was an average of 5.0 grafts per patient (range 3 to 8), with an average of 3.8 endarterectomized vessels per patient (range 3 to 7). There were 14 surgical deaths (10%), all cardiac in origin. Statistically significant (p < 0.01) risk factors for increased operative mortality included repeat surgery, ejection fraction ≤0.30 and age ≥70 years. The operative mortality rate in 106 low risk patients (male gender, age 0.30, first operation) was 3.8% (4 patients). Nonfatal complications included 13 perioperative myocardtal infarctions (10%). Long-term follow-up data are available for all 102 surviving patients for an average of 30 months (range 7 to 92). There were 12 late deaths 1 to 52 months postoperatively. The 5 year actuarial survival rate is 71% for the entire group and 87% for the 106 low risk patients. Seventy-six (75%) of the 102 patients are free of symptoms; 26 (25%) have angina (class II In 18, class III in 4 and class IV in 4). Early graft patency (0 to 3 months) was 89% in vessels in which endarterectomy was required (220 of 248) and 90% for conventional grafts (72 of 80). Late patency (>1 year) is 89% for vessels with endarterectomy (eight of nine) and 71 % for conventional grafts (five of seven). These data demonstrate that coronary artery endarterectomy followed by reconstruction is a reliable method of revascularization otherwise inoperable patients.