Medical treatments often fall out of favor after they have been used for a while and newer treatments become available. For example, a surgical procedure for cleaning out the coronary arteries that was developed in the 1950s is used much less frequently today than coronary bypass surgery. But as the population grows older, cardiologists are seeing more patients with advanced artery disease who are ineligible for bypass operations. Now School of Medicine researchers have determined that many of these patients might benefit from the older procedure, coronary endarterectomy.
To perform this endarterectomy, surgeons open up the chest, cut open the blocked coronary artery, remove the blockage and sew up the artery wall.
The researchers determined outcomes of 177 patients who underwent this procedure between 1986 and 1997 at Washington University Medical Center. "We concluded that coronary endarterectomy can be performed with an acceptable risk and good long-term results in patients whose vessels are not otherwise graftable," said Thoralf M. Sundt III, M.D., associate professor of cardiothoracic surgery. Sundt and colleagues reported their findings in a recent issue of Annals of Thoracic Surgery.
To find out how people with advanced heart disease fare after coronary endarterectomy, the researchers examined computerized medical records of the 177 patients and obtained follow-up data by phone and a questionnaire. The mean interval between the surgery and the follow-up was 56 months.
The patients ranged in age from 39 to 83, with a mean age of 64. Sixty-eight percent of them were men. When compared with 6,919 patients who underwent coronary bypass grafting during the same period, the endarterectomy patients had a greater incidence of high cholesterol levels. Diabetes mellitus and a history of coronary artery bypass grafting also were more common.
The data revealed that 11 patients died from heart attacks in the first 30 days after the endarterectomy, an operative mortality rate of 6 percent. This was slightly higher than the 4.5 percent rate for the bypass patients, but the difference between the two percentages was not statistically significant.
The calculated five-year survival rate was 75 percent or 76 percent, depending on which artery was cleaned out. At the follow-up, 75 percent of 117 survivors were free of angina, 6 percent had had angioplasty, and 3 percent had had more surgery. Only 4 percent had had a heart attack in the intervening years.
"We concluded that coronary endarterectomy can be performed with an acceptable risk and that it should be applied in a selective manner -- to patients whose vessels are not otherwise graftable, Sundt said.