Victor A. Ferraris, John D. Harrah, Dennis M. Moritz, Suellen Ferraris, Martin Striz, Daniela Striz

Cardiovascular Services, Marshall University School of Medicine

Huntington, West Virginia, USA

Coronary endarterectomy (CE) is part of an aggressive revascularization approach to treat diffusely diseased coronary vessels. In order to evaluate the long-term patency of endarterectomized vessels, we studied patients having recatheterization after coronary artery bypass grafting (CABG).

Forty-one clinical and angiographic variables were studied in 97 study patients who had CE and in 154 control patients who did not have CE but who had repeat catheterization after CABG. Multivariate methods were used to identify variables predictive of long-term patency in CE and to compare CE patency to patency in nonendarterectomized vessels.

Ninety-seven patients had 132 CE. The right coronary artery was the most commonly endarterectomized vessel (73 of the 132 endarterectomized vessels). At a mean of 7.1 years of follow-up, significantly fewer endarterectomized vessels were patent compared to nonendarterectomized vessels (40% of endarterectomized vessels compared to 65% of nonendarterectomized vessels in study patients and 58% in control patients, P = 0.0003, Bonferroni Chi²). The graph shows surgical curves for endarterectomized vessels (Study / CE), nonendarterectomized vessels in the study patients (Study/No CE), and nonendarterectomized vessels in control patients (Control/No CE). The only multivariate predictor of long-term patency of endarterectomized vessels is body mass index (P = 0.04).

(chart)

These results show that long-term patency in endarterectomized vessels is less common than in nonendarterectomized vessels and that this patency is related to larger body size. The type of bypass conduit (venous or arterial) used and patient co-morbidities were not significant predictors of long-term CE patency.