Abstract
Background Coronary endarterectomy and patch angioplasty for the left anterior descending (LAD)
artery have been shown to be effective adjunct techniques to surgical revascularization
for severe coronary lesions. The objective of this study is to review the short- and
long-term results of these two methods in our institution.
Methods We retrospectively reviewed 166 consecutive patients who underwent internal thoracic
artery grafting to the LAD, with either adjunct endarterectomy (95 patients) or patch
angioplasty (71 patients) between 2002 and 2014. We compared the early and late outcomes
between groups.
Results The endarterectomy patients were older than the patch angioplasty patients (71 vs.
67 years, p = 0.007) and had lower rates of recent myocardial infarction (25% vs. 45%, respectively,
p = 0.008). Median pulmonary bypass times and aortic cross clamp times were significantly
longer in the endarterectomy group compared with the patch angioplasty group by 47
minutes (p < 0.001) and 42 minutes (p < 0.001), respectively. Median follow-up time was 6.9 years. No significant differences
in operative mortality, perioperative myocardial infarction, and long-term survival
were found. Freedom from percutaneous coronary intervention at 1 and 5 years was significantly
higher in the endarterectomy group compared with the patch angioplasty group (p = 0.002).
Conclusions Endarterectomy and patch angioplasty are comparable methods to reach complete revascularization
for highly selected patients with diffuse atherosclerotic disease in the LAD. Compared
with patch angioplasty, complete extraction of the atherosclerotic plaque with an
endarterectomy leads to similar short-term outcomes and long-term survival while significantly
reducing the need for further interventions in the future.
Keywords
coronary artery bypass graft surgery - coronary artery bypass grafting - endovascular
procedures/stents - outcomes including mortality - morbidity
