MID-TERM RESULTS OF ENDARTERECTOMY IN ADVANCED CORONARY ARTERY DISEASE

OBJECTIVES To compare the angiographic results of patency of endarterectomized vessels vs non endarterectomized vessels and their associated grafts after one year of coronary artery bypass grafting. MATERIALS AND METHODS Study was conducted at the Cardiology Department, Punjab Institute of Cardiology, Jail Road, Lahore from 1st October 2004 till 30th July 2006. 75 consecutive patients were included in the study after undergoing coronary artery bypass grafting and coronary endarterectomy in the hospital. All the patients included in the study were followed up prospectively after 1, 3, 6, 9 and 12 months of coronary artery bypass grafting and angiographic studies were performed at the end of 1 year of follow-up. RESULTS The mean age of the study population was 55.8 +/- 10.1 years. There were 64(85.3%) males and 11(14.7%) females. Hypertension and family history of ischemic heart disease both were present in 40(53.3%) patients. Diabetes mellitus was present in 23(30.7%) patients while 38(50.6%) patients were smokers. A total of 266 grafts were applied to these 75 patients. Of these 181 grafts were applied to non-endarterectomized vessels and 85 to endarterectomized vessels. Follow-up angiography revealed 6(3.3%) blocked grafts in a total of 181 non endarterectomized vessels. Of the 85 endarterectomized vessels, 4(4.7%) grafts with their parent vessels were blocked. Graft patency was not significantly different between endarterectomized and non-endarterectomized grafts (95.3% Vs 96.6%) p<0.11. All patients receiving LIMA to LAD had patent grafts at the end of one year. The blocked grafts were all SVGs. CONCLUSION: The angiographic graft patency rate of endarterectomized vessels and their associated grafts is similar to non endarterectomized vessels. For patients with refractory angina and severe diffuse disease, coronary endarterectomy is an acceptable therapeutic option.