The surgical approach to coronary artery disease has improved a lot during the past two decades. With the widespread use of balloon angioplasty, a growing percentage of surgical patients, have complex coronary pathology. In properly selected patients, coronary endarterectomy has been a valuable adjunt to bypass techiniques by removing obstructing lesions and preparing the distal artery for bypass grafting. Over a 5 years period (1988 to 1993), 2781 patients underwent surgical revascularization at our Instituition (Hospital do Coração). Coronary artery bypass combined with coronary endarterectomy was done in 110 patients. There were 99 men (90%) and 11 women, mean age 58.9 years. For comparation patients were placed into two groups: Group A, patients undergoing endarterectomy to one artery, 104 patients - 94.5%. Group B, patients with more than one endarterectomy - 6 patients 5.4%. Perioperative myocardial infarction envolving the area supplied by the endarterectomized artery occurred in 6.3%, (7 patients). In 3 (2.7%) the infarction was not related with the endarterectomized artery. Complications during the post-operative period were: arrhythmia in 26 patients (23.6%), return to the operation room for control of bleeding in 12 (10.9%), acute renal failure in 10 (9%), and low cardiac output in 4 (3.6%) patients. Operative mortality rate was 4.5% (5/110), due to low cardiac output and multiple organs failure; 4 (3.8%) patients belonged to Group A and 1 to Group B (16.6%). This study demostrates that multiple bypass grafting and adjunt coronary endarterectomy, can yeld good clinical results in patients with difuse coronary artery disease, many of whom would otherwise be inoperable.
coronary artery; revascularization; surgery