Coronary artery endarterectomy: a method of myocardial preservation

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Biology

Background:

• Severe coronary artery disease (CAD) poses challenges when suitable coronary arteries for grafting are unavailable.
• Standard bypass surgery may be insufficient for patients with extensive arterial disease and debris.
• Alternative strategies are needed to manage complex CAD cases effectively.

Purpose of the Study:

• To evaluate the efficacy of combining coronary bypass surgery with coronary endarterectomy and retrograde coronary sinus cardioplegia perfusion.
• To assess the feasibility of this combined approach in patients with near inoperable CAD.
• To determine the outcomes and mortality rates associated with this technique.

Main Methods:

• A cohort of 72 patients with near inoperable CAD underwent combined coronary bypass surgery and endarterectomy.
• Retrograde coronary sinus cardioplegia perfusion was employed to facilitate debris flushing and extend ischemic time.
• Endarterectomy was performed on single or multiple vessels as needed, with a focus on the left coronary artery system.

Main Results:

• The combined approach successfully managed 72 high-risk patients, with one-third requiring multi-vessel endarterectomy.
• A significant proportion of patients had diabetes mellitus, and nearly 60% underwent left coronary artery endarterectomy.
• The mortality rate for left system endarterectomy was 5.7%.

Conclusions:

• Coronary endarterectomy, as an adjunct to bypass surgery, is a viable option for managing high-risk patients with severe CAD.
• The combined technique, including retrograde perfusion, can extend ischemic times and clear arterial debris.
• This approach expands treatment possibilities for patients with limited grafting options.