Abstract P56: Early and Mid-Term Outcome of LAD Endarterectomy and Left Internal Mammary Artery Bypass in Patients with Severe Coronary Artery Disease with Poor Targets

Abstract

Background: With the advancement of percutaneous trans-coronary angioplasty and stenting, patients referred for bypass grafting (CABG) are usually higher-risk and have advanced coronary artery diseases (CAD). The distal targets are frequently diffusely calcified and not amenable for stenting or even CABG. The objective of this study is to review the outcome of endarterectomy in the LAD, in addition to conventional left internal mammary artery (LIMA). Methods: Between September 2005 to June 2010, 52 consecutive patients operated on for severe multi-vessel CAD affecting the LAD were managed with endarterectomy, with or without patch (vein or LIMA) reconstruction, in addition to LIMA grafting of the LAD (Group E). Their medical records were reviewed retrospectively and patients followed prospectively. Another 52 matched-control patients operated on with conventional CABG (Group C) over the same period were used to compare their clinical outcome. CT angiography was performed in 24 Group E patients between 3-23 months post-operatively. Continuous variables were expressed as mean±SD and categorical variables were expressed as absolute numbers. All variables were analyzed with univariate and multi-variate analysis to determine whether any single factor influenced outcome. P<0.05 is considered significant. Results: The demographic characteristics, operative data between groups were recorded. All patients remain free of angina or symptoms of congestive heart failure with zero 30-days mortality. Compared with control, post-operative inotropic/pressor requirements were significantly lower (p= 0.001), despite longer surgery time (p<0.0001) in group E. CT-angio showed LIMA graft patency in all studied Group E patients. Although the median ICU stay was significantly longer in endarterectomy patients (p<0.0001), the overall hospital stay was similar between groups (p=0.76). Conclusions: In patients with diffused LAD disease, the use of extensive endarterectomy with or without patch reconstruction followed by LIMA graft offers a safe alternative for complete revascularization. Alternative techniques with excellent early results can be considered in poor coronary distal beds before rendering the patients non-operable.