Coronary endarterectomy in the left anterior descending artery
Shuichiro Takanashi1, Toshihiro Fukui, Yuji Miyamoto
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan. takanashi-s@gem.hi-ho.ne.jp
Insights
Coronary endarterectomy using left internal thoracic artery (LITA) patch plasty for diffusely diseased left anterior descending (LAD) arteries shows good early outcomes. This surgical method offers favorable functional status and acceptable patency for LAD reconstruction.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Diffuse coronary artery disease presents a significant challenge for cardiac surgeons.
- Coronary endarterectomy, while an option for surgical reconstruction, is not widely adopted.
- This study focuses on the left anterior descending (LAD) artery, a common site for diffuse disease.
Purpose of the Study:
- To assess the early clinical and angiographic outcomes of LAD endarterectomy using left internal thoracic artery (LITA) patch plasty.
- To evaluate the coronary artery velocity flow reserve (CFVR) in the endarterectomized LAD.
Main Methods:
- Retrospective review of 148 patients undergoing LAD endarterectomy with in situ LITA.
- Reconstruction of the LAD using a longitudinally incised LITA as a patch plasty.
- Early postoperative assessment of CFVR via transthoracic echocardiography and angiography.
Main Results:
- The procedure had an operative mortality of 2.7% and low cardiac output in 6.1% of patients.
- Angiographic patency of the LITA to LAD graft was 94.0%.
- Mean CFVR in the endarterectomized LAD was 2.41±0.66, indicating favorable flow.
Conclusions:
- LAD endarterectomy with LITA patch plasty demonstrates acceptable mortality, morbidity, and angiographic patency.
- Early functional assessment via CFVR suggests good results in the reconstructed LAD.
- Coronary endarterectomy is a viable surgical option for patients with diffusely diseased LAD.
Background:
The diffusely diseased coronary artery is a challenge for cardiac surgeons. Although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel, it has not been widely used. We assessed the early clinical and angiographic outcomes of patients undergoing coronary endarterectomy of the left anterior descending artery (LAD) with a patch plasty method using the left internal thoracic artery (LITA). Furthermore, we assessed the coronary artery velocity flow reserve (CFVR) of the endarterectomized LAD.
Methods:
We retrospectively reviewed the records of 148 patients undergoing LAD endarterectomy using the in situ LITA. Direct endarterectomy was performed with a long segmental incision of the LAD that was reconstructed with the longitudinally incised LITA. The mean age at surgery was 65.1±8.6 years. Previous myocardial infarction was observed in 58.1% of the patients. The mean Canadian Cardiovascular Society score was 2.4±0.9. Postoperative angiography was performed in 134 patients (91.2%) during the same hospitalization (mean, 11.2±9.0 postoperative days). CFVR in the LAD was measured early after the operation by transthoracic echocardiography.
Results:
The mean number of distal anastomoses per patient was 4.2±1.3. The mean length of reconstructed LAD with endarterectomy was 5.8±1.5 cm. The operative mortality was 2.7%. Low cardiac output occurred in 6.1% of the patients. Perioperative myocardial infarction was observed in 12.2% of the patients, but severe ventricular arrhythmia was not encountered. The patency rate of the LITA to LAD was 94.0% by early angiographic examination. The mean CFVR in the endarterectomized LAD was 2.41±0.66.
Conclusions:
Coronary endarterectomy of the LAD with a patch plasty using the LITA is associated with acceptable mortality, morbidity, and angiographic patency. CVFR measured by transthoracic echocardiography showed a favorable functional status in the endarterectomized LAD. Endarterectomy is considered to be one of the available surgical methods for patients with a diffusely diseased LAD.
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