The Annals of Thoracic Surgery, Vol 31, 28-35, Copyright © 1981 by The Society of Thoracic Surgeons
Patency and flow response in endarterectomized coronary arteries
ML Kamath, DH Schmidt, PM Pedraza, FM Blau, A Sampathkumar, LL Grzelak and WD Johnson
Ninety patients, operated on from May, 1978, through June, 1979, underwent
coronary endarterectomy and early recatheterization. Patency of grafts to
endarterectomized arteries was 103 of 118 (87.3%) and patency of
conventional vein grafts in the same patients was 217 of 233 (93.1%).
Myocardial blood flow using xenon 133 washout, at rest and with
isoproterenol-induced stress, was measured in 7 normal coronary arteries,
28 conventional saphenous vein grafts, and 33 saphenous vein grafts to
endarterectomized coronary arteries. The increase in myocardial blood flow,
from rest to isoproterenol-induced stress, was comparable for the three
groups. The endarterectomized group was divided further by separating out
the 10 patients with heavy scarring or residual disease. The remaining
patients had a flow response identical to those with conventional saphenous
vein grafts. The rate of perioperative infarction in patients receiving
endarterectomy was 3 of 113 (2.6%), as measured by appearance of new
persistent Q waves on the serial postoperative electrocardiogram. Positive
pyrophosphate scans were noted in 12 of 105 (12.4%) patients. It is
concluded that, in the early stages at least, grafts to endarterectomized
coronary arteries stay open and perfuse the myocardium as well as
conventional saphenous vein grafts unless the myocardium is heavily scarred
or unless residual disease remains.
