EARLY OUTCOMES OF CLOSED VERSUS OPEN LEFT ANTERIOR DESCENDING ARTERY ENDARTERECTOMY IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Abstract

Patients with complex coronary artery disease are candidates for coronary artery bypass grafting. Coronary endarterectomy as an adjunct technique to CABG could be used in a patient with diffused CAD for receiving complete revascularization. Coronary endarterectomy is an old procedure which was designed to treat coronary artery stenosis by removing the atherosclerotic plaques causing the stenosis from inside coronary arteries rather than bypassing the stenosis. In its earlier days, endarterectomy results were discouraging and were overshadowed by the success of CABG in treating ischemic heart disease. However with advances in perioperative care and mechanical circulatory support, it has been revisited as an adjunct to conventional CABG in treating patients with diffuse coronary artery disease. Left anterior descending artery endarterectomy can be done by one of two most famous methods which are namely the closed and the open endarterectomy. In the closed endarterectomy a small arteriotomy is done and blind controlled traction applied on the atherosclerotic plaque in order to deliver it from the arteriotomy. In the open method a generous arteriotomy is created to be able to dissect and pull out the atherosclerotic plaque from the coronary artery under direct vision. This large arteriotomy is then reconstructed using the internal mammary artery itself as an onlay patch or using a patch fashioned from saphenous vein with the internal mammary artery then anastomosed to it. The purpose of this study is to determine the impact of CE method on early clinical outcomes of patients undergoing CABG with CE and to identify independent risk factors of adverse outcomes by comparison both groups of patients undergoing CE by the two methods; group A (20 patients): open LAD-CE versus group B (20 patients): closed LAD-CE. In summary, patients with extensive and diffuse coronary artery disease are high-risk candidates with coexisting morbidities. Myocardial revascularization procedure in such a group is challenging without CE. This study indicated that despite higher risk profile, both short-term and mid-term outcomes after open CE with CABG are either comparable or were similar to closed CE with CABG. In selected individuals with diffuse coronary artery disease; CE still remains a surgical tool for complete myocardial revascularization with an acceptable outcome, which may further be improved by either eliminating or modifying several risk factors that result in adverse postoperative outcomes.