ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Complex Coronary Revascularization: Endarterectomy, Patch Plasty and Jump Bypass
Bayındır Tıp Merkezi Toraks ve Kalp Damar Cerrahisi Kliniği
In this study, experience with the patients who had been revascularized by using techniques of endarterectomy, patch plasty or jump bypass due to diffuse coronary disease will be described.

From 1992 to April, 1998, coronary bypass was performed on 3053 cases. Due to diffuse coronary artery disease endarterectomy, patch plasty and/or jump bypass techniques were performed in 214 patients. There were 170 male (80%), and 44 female (20%) patients; whose ages ranged from 35 to 78 (m: 56.9±9.3). Twelve patients underwent coronary bypass without cardiopulmonary bypass. Number of distal bypasses were between 1-7 (m: 3.9±1.2). Jump bypass in 67 cases, closed endarterectomy in 6 cases, patch plasty with or without endarterectomy in 54 cases was performed to diffusely diseased left anterior descending artery. Jump bypass was not used; closed endarterectomy in 61 cases, patch plasty in 23 cases, open endarterectomy vvith patch plasty in 18 cases were made in other diffusely diseased coronary arteries. Aneurysmectomy in 11 cases, mitral valve replacement in 1 case, aortic valve replacement in 1 case, coronary-pulmonary artery fistula ligation in l case, and cholecystectomy in l case were performed as associated procedures.

In the early postoperative period, reoperation due to excessive bleeding was performed on 5 patients (2.3%), and there was a case of cerebrovascular accident in 5 patients (2.3%). Perioperative myocar- dial infarction was detected in 1 case (0.5%). Two patients died because of low cardiac output (0.9%). All survived cases has been followed, and follow-up time ranged from 1 to 61 months (m: 13.5+13.2 months), 2853 patient-months. In 14 symptomatic cases, 15 control coronary arteriographies has been performed after 2 to 33 months postoperatively (m: 16.6±10.5 months). Coronary arteriography revealed a graft patency of 67.8% in overall, 63.2% in coumplex bypass grafts, and 70.3% in conventional grafts.

Endarterectomy, patch plasty, and jump bypass techniques, that are performed on diffusely diseased coronary arteries, offer good surgical outcomes, do not compromise early postoperative period, and have tolerable long-term results.
Key words:coronary artery bypass surgery, endarterectomy, patch plasty, jump bypass, left anterior descending artery

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