TREATMENT OF DIFFUSE AND DISTAL CORONARY ARTERY DISEASE, EXPERIENCE
IN OVER 3.000 OPERATED PATIENTS
N. Radovanović, S. Ničin, M. Zorc1, Lj. Petrović, J. Selestiansky,
M. Fabri, B. Mihajlović and P. Kovačević . .
Clinic of Cardiovascular Surgery, Novi Sad, Institute of Histology1,
Medical Faculty, Ljubljana, Slovenia, Yugoslavia
Out of the
total number of 10224 patients who had undergone myocardial revascularisation,
3200 (31,3%) had an additional endarterectomy (EA) on one or several
coronary vessels. Postoperative mortality -30 days (PM) was 5,1%.
Our technique is closed and manual EA. We used extensive EA, complementary
procedure for direct myocardial revascularisation with bypass
grafting. However total EA is EA of the whole coronary artery,
and this is the new effective possibility for direct myocardial
revascularisation with patch reconstruction of coronary artery
and without by-pass grafting. In 1998 we introduced Prostacyclin
as a "bridge to heparinisation", based on the useful effect in
prevention of early thrombosis in microcirculation during and
after cardiopulmonary by-pass and EA. Endarterectomy is most often
performed in re-do coronary -54% in our series in patient with
ejection fraction (EF) lower than 30%-52% and in patient with
EF < 20%-56%. We dedicate special attention to the EA of the first
septal coronary artery. In this group of 553 (18,3%) high risk
pts was 8,6%. Early recoronarography has shown good patency of
grafts. Most patients are free of angina and have an improved
tolerance of effort. Long term results, show that the survival
rate is over 90% with SE±3,0%, infarction - free rate is 87% (SE±2,0%)
and angina free rate is over 95% (SE±3,0%), at five years over
75%, 80%,75% at 10 years respectively.
Thanks to use of EA we can successfully operate in end-stage coronary
arteries disease. Extensive or total EA is the best procedure
for revascularisation of the septum. Frequent and repeated application
of angioplasty delays surgical revascularisation but later, in
the stage of diffuse and distal coronary disease, EA is unavoidable.
In the future we expect more frequent application and further
development of technique of coronary arteries endarterectomy .