[Off-pump Coronary Artery Bypass Grafting with Concomitant Coronary Endarterectomy for the Diffusely Diseased...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Surgery

Background:

• Percutaneous coronary intervention advancements increase referrals for surgical revascularization in complex coronary artery disease.
• Coronary endarterectomy (CE) is a viable option for treating diffusely diseased coronary arteries.
• Off-pump coronary artery bypass grafting (CABG) is the established standard for surgical revascularization.

Purpose of the Study:

• To evaluate the safety and efficacy of off-pump CABG with concomitant CE for diffusely diseased left anterior descending (LAD) arteries.
• To assess early postoperative outcomes, including graft patency and perioperative complications.

Main Methods:

• A retrospective analysis of 194 patients undergoing off-pump CABG with CE for LAD disease between September 2004 and August 2015.
• LAD arteriotomy reconstruction using internal thoracic artery (ITA) onlay-patch grafting.
• Assessment of on-pump conversion rates, perioperative myocardial infarction, 30-day mortality, and early graft patency via angiography.

Main Results:

• The study included 194 patients (mean age 66.5±8.9 years, 168 males) with a mean ejection fraction of 54.9±12.4%.
• Mean arteriotomy length was 6.1±1.9 cm; 6.7% required on-pump conversion, and 8.8% experienced perioperative myocardial infarction.
• The 30-day mortality was 1.0%, with an early postoperative patency rate of 93.3% for the reconstructed LAD.

Conclusions:

• Off-pump CABG combined with CE and ITA onlay-patch grafting is a safe procedure for diffusely diseased LAD arteries.
• This technique yields satisfactory outcomes and high graft patency rates, making it a valuable option for complex coronary artery disease.
• The study supports the use of this combined surgical approach in selected patients with diffuse coronary artery disease.