Coronary "open" endarterectomy and reconstruction: short- and long-term results of the revascularization with saphenous vein versus IMA-graft

L. Beretta, M. Lemma, P. Vanelli, D. DiMattia, G. Bozzi, P. Broso, A. Salvaggio, C. Santoli

Research output: Contribution to journalArticle

Abstract

From June 1984 to December 1990, 96 patients underwent "open" coronary endarterectomy and reconstruction. In 50 patients (group 1), a saphenous vein (SV) graft was used to reconstruct and bypass 54 coronary vessels. In 46 patients (group 2), 46 coronary vessels were reconstructed with an SV patch and then bypassed with the internal mammary artery (IMA): Seventy-four LAD coronary arteries (36 in group 1 and 38 in group 2) were treated with these procedures. Operative mortality was 8% in group 1 and 2.1% in group 2. Five patients (10%) in group 1 and 1 patient (2.1%) in group 2 developed perioperative myocardial infarction. The early postoperative patency of the reconstructed vessels was 84.6% in group 1 and 92.5% in group 2. Angiographic controls were performed between 30 and 36 months after operation in 18 patients (72%) of group 1 and in 16 patients (69%) of group 2 with patency rates of 66.7% and 81.5%, respectively. A further angiographic study performed between 54 and 60 months after operation of 9 22 patients of group 1 and 5 9 patients of group 2 did not show any additional closure of the endarterectomized vessels. Three- and 5-year survival analyzed by the Kaplan-Meier method was 79.6% and 69.7%, respectively, in group 1 and 86.8% for both the 3- and 5-year survival in group 2. After a mean follow-up of 51.0 and 35.5 months, 62.8% of the surviving patients of group 1 and 75.6% of group 2 were asymptomatic. In our experience, the IMA, which we used to revascularize the coronary arteries treated with "open" EA, improves (although not significantly) operative and long term results obtained with saphenous veins. "Open" EA and reconstruction is a worthwhile procedure in patients with diffuse coronary artery disease. The operative, angiographic, and functional results are acceptable and should be acknowledged with reference to patients otherwise considered inoperable.

Original languageEnglish
Pages (from-to)382-387
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume6
Issue number7
Publication statusPublished - 1992

Keywords

  • Coronary artery disease
  • Coronary endarterectomy
  • Internal mammary artery graft
  • Myocardial revascularization

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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