Results of combined coronary endarterectomy and coronary bypass for diffuse coronary artery disease

Abstract

The treatment of diffuse distal coronary artery disease is presently unsatisfying. Coronary artery bypass grafting (CABG) is usually not successful in these circumstances. Mechanical endarterectomy of a distal coronary artery combined with coronary artery bypass grafting (E-CABG) has been performed 26 times at this institution. Follow-up catheterization 6 months after operation revealed that 14 of the first 20 grafts studied were patent (70 percent). Twenty endarterectomies were performed to the distal right coronary artery, three to the distal left anterior descending coronary artery, two to the circumflex / obtuse marginal arteries, and one to the first diagonal coronary artery. The average flow in these patent grafts at the time of operation was 87 ml. per minute (range 30 to 200 ml. per minute). Intraoperatively, the six nonpatent grafts had flows averaging 27 ml. per minute. All of these patients had concomitant CABG's without endarterectomy to other coronary arteries. There were two perioperative myocardial infarctions. There were no early or late deaths. A literature survey shows that 605 CABG's constructed to endarterectomized coronary arteries have undergone postoperative catheterization. Four hundred seventy-seven (79 percent) of these E-CABG's were patent from 3 weeks to 2 years following operation. Histologic studies demonstrate that a neointima is formed over the endarterectomized surface. Neither thrombosis nor the recurrence of atherosclerosis seems to be the problem that many have feared. The present series, as well as the combined series from the literature, lends encouraging support to the value of E-CABG for the treatment of a diffusely diseased distal coronary artery.