| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2000;69:1743
© 2000 The Society of Thoracic Surgeons
DR WILLIAM A. BAUMGARTNER (Baltimore, MD): I had just one question. This is a very selective group of patients, as you have commented, as far as the use of the internal mammary artery. It seemed low to me, 60% use in one group and 59% in the other. Is that because of a selection bias?
DR FERRARIS: I think partly it is the surgeon who did most of these in the early portion of the study. He adapted the use of the internal mammary artery late in the progression of things. Probably in the 10- to 15-year range, most of those patients did not have an internal mammary artery graft.
DR BAUMGARTNER: I see. I had another question, that is, in the early days of coronary endarterectomy, we used to think that warfarin was necessary for all the patients. I wonder if you could suggest what we should be using for these patients, because I think all of us still do endarterectomies depending on the clinical situation.
DR FERRARIS: We routinely use warfarin for 3 months after endarterectomy. There are at least four studies from the angioplasty literature that show that aspirin is not enough when you disrupt a vessel. By analogy, you can say that endarterectomy is something like what might happen with a stent or a percutaneous transluminal coronary angioplasty. So we have chosen to place people on warfarin. There are no control data as far as I know that can answer that question.
DR THORALF M. SUNDT III (St. Louis, MO): That is a lovely study and a tremendous amount of work. I think it is a real contribution to the literature to have this information.
One of the issues that we have been interested in with the recent approval of transmyocardial revascularization for diffuse coronary artery disease is how one decides whether to perform an endarterectomy or to do transmyocardial revascularization. Do you have any thoughts that you would like to share with us about this question?
DR FERRARIS: I wish I did. I think that many of the patients who are candidates for endarterectomy are probably candidates for transmyocardial laser revascularization. It would be very hard to plan or organize a study to compare that in a meaningful way. So much of what we do is an art and not a science, and this is sort of more on the art side than the science side.
DR NORMAN SNOW (Chicago, IL): Are you aware of how the endarterectomies were done? There are local endarterectomies and then there are the extensive Dudley Johnson endarterectomies. Were you able to control for how many surgeons did the endarterectomy, the technique of the endarterectomy, and what extent it was? That might have some bearing on outcome. It would seem important to have that information.
DR FERRARIS: There were only two surgeons who performed the endarterectomies, and they were all performed essentially the same way. Doctor Noel Mills has a very elegant paper about the techniques and some really wonderful little instruments that are available to do the endarterectomy. The technique was basically a small arteriotomy followed by proximal and distal dissection with dental freer and using the sort of delicate instruments available for endarterectomy. We routinely used dextran flushed into the vessel distally and proximally, and then, as I said, we used anticoagulation postoperatively.
DR HAROLD C. URSCHEL, JR (Dallas, TX): In the old days, coronary endarterectomy without coronary artery bypass did not do as well. We found that using carbon dioxide in the left anterior descending coronary artery produced a much better endarterectomy than we could get mechanically. Have you used carbon dioxide at all?
DR FERRARIS: No, I have not. There are other things that have been used as well. There has been a report about using cardioplegia solution injected into the endarterectomy plane. We did not use any of those adjunctive techniques.
DR URSCHEL: In the left anterior descending it is far superior to any mechanical endarterectomy.
| ||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
