Abstract
Background: Coronary Endarterectomy (CE) is the expulsion of the atheromatous plaque, and isolating the outer media and adventitia layers of arterial wall. Objective of this study was to review the consequences of coronary endarterectomy (CE) with coronary artery bypass grafting (CABG), and demonstrate the outcomes of this surgical technique for patients with diffuse coronary artery disease in a single surgeon’s practice.
 Methods: Retrospectively outcome of 1473 endarterectomised coronary artery in 1189 patients with diffuse coronary artery disease (CAD) was reviewed, who have had experienced CE with OPCABG in the year of 2007 to 2016. CE was performed in multi-segmental diffuse CAD, or when a calcified or extremely thick plaque making anastomosis troublesome.
 Results: Approximately 75.0% coronary endarterectomy were performed in the left coronary territory and most commonly left anterior descending artery was endarterectomized (42.83%). An average of 1.2 coronary endarterectomies performed per patient. Post-operative ICU and 30-days mortality rate was 2.2%, and 0.6% respectively in CE group. Post-operative atrial fibrillation, acute MI, neurological complication, and blood transfusion were significantly higher in CE group. Following CE, Kaplan–Meier cumulative survival rate was 89.5%, and about 85% patients were free from angina at follow-up of 5 years.
 Conclusion: Coronary endarterectomy with OPCABG is attainable, and accomplishes surgical revascularization in patients; when there is no other alternative for total myocardial revascularization.
 Bangladesh Med Res Counc Bull 2018; 44: 124-131
Highlights
Ischaemic heart disease (IHD) patients, who are referred for coronary artery bypass graft (CABG) surgery are progressively getting more complex with multiple comorbidities, and subsequently, this group of patients have diffuse coronary artery disease, which has made complete surgical revascularization more difficult.[1]
Two-third Coronary Endarterectomy (CE) were performed in the left coronary territory and in 42.83% cases left anterior descending (LAD) required endarterectomies and grafted with LIMA (Left internal mammary artery)
This study evaluated the outcomes of coronary endarterectomy in coronary artery bypass grafting (CABG) surgery having diffuse coronary artery disease (CAD) and shown that the complete revascularization of diffuse CAD enhanced the early and late post-operative outcomes following CABG
Summary
Ischaemic heart disease (IHD) patients, who are referred for coronary artery bypass graft (CABG) surgery are progressively getting more complex with multiple comorbidities, and subsequently, this group of patients have diffuse coronary artery disease, which has made complete surgical revascularization more difficult.[1]. Coronary endarterectomy is frequently important to perform optimal myocardial revascularization during CABG surgery, or to encourage anastomosis of severely calcified and diffusely diseased coronary arteries.[3,7] The principle indication for CE technique is the presence of diffuse coronary artery disease with leaping lesion, that are not feasible to achieve distal bypass grafting. Coronary Endarterectomy (CE) is the expulsion of the atheromatous plaque, and isolating the outer media and adventitia layers of arterial wall. Objective of this study was to review the consequences of coronary endarterectomy (CE) with coronary artery bypass grafting (CABG), and demonstrate the outcomes of this surgical technique for patients with diffuse coronary artery disease in a single surgeon’s practice
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