Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery

Coronary endarterectomy (CE) is a surgical option for a diffusely diseased coronary artery. This study evaluated the clinical and angiographic outcomes of CE for a diffusely diseased left anterior descending artery (LAD) using the internal thoracic artery (ITA).

From September 2004 to September 2014, 188 patients (163 men; mean age, 66.1 years) underwent coronary artery bypass grafting with CE for a diffusely diseased LAD. Forty patients (21.3%) had unstable angina, and 55 (29.3%) were at Canadian Cardiovascular Society class 3 or 4. Mean ejection fraction was 0.55. Endarterectomy was performed under direct vision through a long arteriotomy in all patients. Angiographic evaluation was performed before discharge and at 1 year after the operation.

Mean arteriotomy length was 6.1 ± 1.8 cm. The endarterectomized LAD was reconstructed using the left ITA in 179 (95.2%) or the right ITA in 9 (4.8%). The operation was conducted off pump in 185 patients (98.4%). The 30-day mortality was 1.1%. Perioperative myocardial infarction occurred in 17 patients (9.0%). The patency rate of the ITA and LAD at early postoperative and follow-up angiography was 91.6% and 96.6%, respectively. Optical coherence tomography performed in 8 patients revealed that the endarterectomized LAD was completely endothelialized and that the surface of the reconstructed lumen had become homogeneous within 1 year after the operation. The median follow-up period was 5.8 years. At 5 years, freedom from all-cause death was 89.3% ± 2.4% and freedom from major adverse cardiac and cerebrovascular events was 74.0% ± 3.3%.

CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.