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J Thorac Cardiovasc Surg 2002;124:553-560
© 2002 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Departments of Cardiovascular Surgerya and Cardiology,b Policlinico S. Orsola, University of Bologna, Bologna, Italy.
Received for publication Nov 28, 2001. Revisions requested Dec 13, 2001; revisions received Feb 25, 2002. Accepted for publication March 11, 2002. Address for reprints: Bruno Chiappini, MD, Department of Cardiovascular Surgery, University of Bologna, via G. Massarenti, 9-40138 Bologna, Italy (E-mail: bruno_chiappini{at}hotmail.com).
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%.
Conclusion: Coronary endarterectomy is a safe and effective procedure for achieving a complete revascularization in patients with end-stage coronary disease.
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