Early results of the advanced coronary endarterectomy combined with CABG in the treatment of coronary artery occlusive disease.

BACKGROUND. Coronary Endarterectomy is a controversial but effective procedure for diffuse coronary artherosclerosis. Between April 1991 and January 1993, 57 patients in VGH-Taipei who had their diffuse coronary artery disease treated with combined endarterectomy and coronary artery bypass grafting (CABG). METHODS. One hundred and thirty-eight endarterectomies were performed, including 6 on the left main coronary artery system, 77 on the left anterior descending coronary artery system, 15 on left circumflex coronary artery system and 40 on the right coronary artery system (an average of 2.42 endarterectomies/patient). For graft conduit, great saphenous vein was used in 149 anastomoses, left internal mammary artery in 21, right internal mammary artery in 6 and right gastroepiploic artery in 4. The mean number of distal graft anastomoses was 3.15 per patient. Additional procedures were performed in 8 patients (14%): two patients required aortic valve replacement, one patient had mitral valve replacement, one had mitral annuloplasty, one had VSD repair and three had left ventricle aneurysm plications. The mean aortic clamp time was 108.8 +/- 30.5 minutes. RESULTS. The early mortality rate was 5.3%. The late mortality rate was 3.5%. During follow-up of mean 17.5 months, 98% of survivors were asymptomatic or in improved condition. CONCLUSIONS. Although endarterectomy is still a debatable procedure, it is valuable especially for the diffusely diseased arteries.