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Coronary Endarterectomy or Patch Angioplasty for Diffuse Left Anterior Descending Artery Disease

Ohad Bitan1,2, Paul A Pirundini3, Eyal Leshem1,2

  • 1Department of Internal Medicine C, The Chaim Sheba Medical Center, Tel Hashomer, Israel.

The Thoracic and Cardiovascular Surgeon
|March 19, 2017
PubMed

Insights

Coronary endarterectomy and patch angioplasty offer comparable outcomes for severe left anterior descending artery disease. Endarterectomy significantly reduces the need for future interventions compared to patch angioplasty.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Coronary endarterectomy and patch angioplasty are adjuncts to surgical revascularization for severe coronary lesions.
  • These techniques are applied to the left anterior descending (LAD) artery.

Purpose of the Study:

  • To review the short- and long-term results of endarterectomy versus patch angioplasty for LAD artery disease.
  • To compare the efficacy and outcomes of these two surgical methods.

Main Methods:

  • Retrospective review of 166 patients undergoing internal thoracic artery grafting to the LAD.
  • Comparison between patients receiving adjunct endarterectomy (95) and patch angioplasty (71) between 2002 and 2014.

Main Results:

  • Endarterectomy patients were older and had fewer recent myocardial infarctions.
  • Longer bypass and cross-clamp times were observed in the endarterectomy group.
  • No significant differences in mortality, perioperative myocardial infarction, or long-term survival were found.
  • Freedom from percutaneous coronary intervention was significantly higher in the endarterectomy group at 1 and 5 years.

Conclusions:

  • Endarterectomy and patch angioplasty are comparable for complete revascularization in selected patients with diffuse LAD atherosclerotic disease.
  • Endarterectomy, involving complete plaque extraction, yields similar short-term and long-term survival to patch angioplasty.
  • Endarterectomy significantly reduces the requirement for future interventions compared to patch angioplasty.
Abstract

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