Coronary endarterectomy on beating heart: is it worth doing?

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Anesthesia

Background:

• Management of patients with severely impaired left ventricular function (LVF) and diffuse coronary artery disease presents a significant clinical challenge.
• Coronary revascularization in such cases often necessitates endarterectomy to facilitate anastomosis, posing technical difficulties.
• The study evaluates the feasibility and benefit of performing endarterectomy during off-pump coronary artery bypass grafting (CABG).

Purpose of the Study:

• To present the surgical experience of performing endarterectomy during off-pump CABG in patients with severely impaired LVF.
• To assess the safety, efficacy, and early outcomes of this combined surgical approach.

Main Methods:

• A cohort of five patients with a mean ejection fraction of 27% underwent coronary revascularization with endarterectomy using an off-pump technique.
• Procedures included closed endarterectomy of the left anterior descending artery (LAD), right coronary artery (RCA), and intermediate artery.
• Patients were assessed pre- and post-operatively, including clinical status, graft patency, and left ventricular function.

Main Results:

• All five patients survived the procedure, with seven total closed endarterectomies performed.
• One patient experienced a perioperative myocardial infarction (20%), and 40% required inotropic support.
• At a mean follow-up of 14.2 months, all patients were angina-free, with patent bypass grafts in 83.4% and no significant change in ejection fraction.

Conclusions:

• Performing endarterectomy on a beating heart in patients with compromised LVF is technically demanding but achievable.
• Despite a notable incidence of perioperative infarction, the procedure demonstrates promising early clinical outcomes and graft patency.
• This approach may be a viable option for patients with severely compromised LVF previously deemed inoperable.