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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
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Aggressive surgical approach in diffuse coronary artery disease: coronary endarterectomy and early- to mid-term

Umut Serhat Sanrı1, Mehmet Aslan2, Dolunay Odabaşı2

  • 1Alanya Aladdin Keykubat University, Department of Cardiovascular Surgery, Antalya, Turkey.

Cardiovascular Journal of Africa
|August 13, 2026
PubMed

Insights

Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) offers a viable solution for diffuse coronary artery disease (CAD) when standard grafting is not possible. This approach improves left ventricular function, despite increased bleeding risks.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Diffuse coronary artery disease (CAD) presents challenges for surgical revascularization due to lack of suitable distal targets for standard coronary artery bypass grafting (CABG).
  • Coronary endarterectomy (CE) is an alternative technique to bypass obstructed arteries in cases of diffuse CAD.

Purpose of the Study:

  • To evaluate the surgical outcomes, complication profile, and functional recovery of high-risk patients undergoing single or multiple CE combined with CABG.
  • To assess the safety and efficacy of CE in diffuse CAD patients unsuitable for standard CABG.

Main Methods:

  • Retrospective single-centre study of 24 patients with diffuse CAD undergoing CABG with single or multiple CE (January 2022 - December 2025).
  • Data collected included demographics, operative variables, blood product usage, postoperative complications, and functional outcomes (left ventricular ejection fraction - EF).
  • Comparison of EF before surgery and at six-month follow-up.

Main Results:

  • Mean age 61 ± 10 years; 41.7% emergency surgery. 34 lesions treated in 24 patients (mean 1.41 vessels/patient).
  • 30-day mortality rate 8.3%; one-year cumulative survival rate 91.7%.
  • Significant 12% increase in mean EF at six months (p < 0.05). High blood product usage observed (mean 4.3 units PRBC, 5.0 units FFP).

Conclusions:

  • Coronary endarterectomy combined with CABG achieves acceptable mortality and significant improvement in left ventricular function in diffuse CAD patients.
  • Aggressive revascularization using the closed technique is a safe option for multiple coronary arteries in selected patients, despite increased bleeding risk.
Abstract

Keywords:
Coronary endarterectomycoronary bypassdiffuse coronary artery diseasemultiple endarterectomypostoperative bleeding

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