Early and long-term results of combined endarterectomy and bypass grafting

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Early and long-term results of coronary artery bypass grafting depend on an adequate lumen beyond the area of obstruction in the affected coronary artery. It has been our policy not to regard the presence of diffuse peripheral coronary arterial disease or nonvisualization of the distal segment at operation as contraindications to operation. In these patients the artery is explored at operation and, if necessary, additional gas endarterectomy is performed. For this purpose a special set of cannulae designed to deliver CO2 under pressure to the different coronary arteries was used. To evaluate the results of this policy, all patients receiving coronary artery bypass grafts between October 1969 and October 1976 were reviewed. A total of 640 patients received 1345 grafts. In all, 292 arteries were endarterectomized in 212 patients. This represents 33% of the patients and 22% of all grafted vessels. The incidence of risk factors was slightly higher in patients requiring endarterectomy compared to those who did not (Table 1).

The 212 patients received 247 additional grafts to nonendarterectomized arteries, bringing the total number of grafts to 539 or 2.5 grafts per patient. Endarterectomy of the anterior descending artery was performed on 120 occasions and accounted for 41% of all endarterectomies in this series, compared to 160 (55%) for the right coronary artery and 12 (4%) for the circumflex artery. Additional procedures were performed in 18 patients (9%) and included excision of left ventricular aneurysm or scar in 11, mitral valve repair or replacement in 3, and aortic valve . . .



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