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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

SURGICAL 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 . .
IUUniversity 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.
Conclusion: 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 .

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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