Abstract

Aakash Dinesh Joshi64025*, Prashant Harsur64026 and Vivek Pillai64027

Complete revascularization of coronary arteries, and mainly of the Left Anterior Descending artery (LAD) which plays a significant role in terms of postoperative outcomes, is the primary objective in Coronary Artery Bypass Grafting (CABG). Nowadays, more and more patients having stenosis in one or two coronary vessels tend to be treated by Percutaneous Coronary Intervention (PCI). As a result, diffuse Coronary Artery Disease (CAD) is more likely among patients referred for CABG. However, up to 25% of patients with diffuse CAD cannot be safely and successfully treated by standard CABG. Therefore, several techniques including Coronary Endarterectomy (CE), which involves the removal of the atherosclerotic core from the coronary artery lumen through an arteriotomy, have been proposed to expand surgical possibilities.

Total of 62 patients underwent coronary artery bypass grafting with coronary endarterectomy. 62 patients fulfilled inclusion our study and were followed up. Out of 62, more than half of patients had four grafts (51.6%), followed by five grafts (27.4%), three grafts in 16.1% of patients and six graft in 3.2% of patients. Out of total patients 32 (51.6%) patients had 3 venous grafts, followed by 17 (27.4%) patients had 4 venous grafts, 10 (16.1%) patient had 2 venous graft and one patient (1%) with one venous graft in our study.

In our study, we used Left Internal Mammary Artery (LIMA) to anastomosed with LAD in 60 patients which constitutes 96.8%, 11 patients had only right coronary artery bypass grafting with 1.6% of patients, LAD+Right Coronary Artery (RCA)+Posterior Descending Artery (PDA). Additionally LAD+RCA were territory was grafted in one patient. Out of 62 patients, LAD was endarterectomized in 15 patients and 24.2% and endarterectomy for PDA artery was done in 7 patients (11.3), followed by second Obtuse Marginal (OM-2) in 4 patients (6.5%), first Obtuse Marginal (OM-1) in 2 patients (3.2%), OM-3 in 1 patient (1.6%) and lastly distal RCA in 1 patient (1.6%). Total mortality till date was 5 (8.06%) and 1 in hospital mortality due to multi-organ dysfunction syndrome out of total 62 patients.

In the recent decades, the treatment of older patients with diffuse CAD, alongside multiple comorbidities and high expectations for successful treatment, has become a real challenge. CE is a surgical method that can provide acceptably effective and safe results in the treatment of CAD. CE as an adjunct to CABG has a significant role in achieving adequate revascularisation and in improvement of long term outcomes.