Coronary Endarterectomy Improve Left Ventricle Ejection Fraction After Coronary Artery Bypass Grafting Surgery

Abstract

The diffusely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel. It may assures complete revascularization of myocardium in case of diffusely diseased vessels and prevent residual ischemia but it has not been widely used. recently cardiac surgeons are performing and increasing number of coronary artery endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass grafting surgery. we reviewed the early clinical and hemodynamic out comes with echocardiography of 22 patients undergoing coronary artery endarterectomy of left anterior descending artery (LAD) diagonal branches (D1 or D2) and right coronary artery and posterior descending artery (RCA and PDA) with patch plasty method using left internal mammary artery (LIMA) and saphenous vein graft (SVG) between January 2017 and June 2018. mean follow up of all patients were 3-6 months postoperatively, Left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with endarterectomy and artery patch plasty in 12 (54, 5%) patients, saphenous vein graft (SVG) anastomosed to left anterior descending artery (LAD) with endarterectomy and vein patch plasty in 2 (9%) patients, and saphenous vein graft (SVG) to Right coronary artery (RCA) Diagonal (D1) and posterior descending artery (PDA) with endarterectomy and vein patch plasty in 9 (40.9%) patients. Postoperative mortality was 0% and echocardiographic assessment done by modified Simpson method on outpatient department (OPD) basis, 7 patients had left ventricle ejection fraction of (50-55%) preoperatively with no changes on postoperative period and 7 patients had improvement of left ventricle ejection fraction from (30-35%) preoperatively to (40-45%) in postoperative period. principle goal in coronary artery bypass grafting surgery (CABG) is to achieve complete revascularization of diseased coronary arteries, in particular the left anterior descending artery (LAD) is very important vessel because incomplete revascularization of the LAD has been proven to be a predictor of worse mortality after coronary artery bypass grafting surgery (CABG). Recent publications have revealed that coronary endarterectomy is a safe procedure and demonstrated favorable long term out comes. In our experience coronary endarterectomy has been performed with good clinical and hemodynamic out comes with echocardiography.