Coronary endarterectomy on beating heart: is it worth doing?
BACKGROUND
Management of patients with severely impaired left ventricular function (LVF) associated with diffusely atheromatous coronary artery disease is a real dilemma. Coronary revascularization can be done only after endarterectomy to facilitate anastomosis. The aim of the present work is to present our experience and see whether performing endarterectomy during off-pump bypass can be of any benefit.


METHODS
Five patients with a mean ejection fraction of 27 +/- 4.5 underwent coronary revascularization facilitated by endarterectomy using off-pump technique. There were three males and two females with a mean age of 64.4 +/- 7.4 years. All patients were in NYHA class III or IV. Close endarterectomy was done to left anterior descending artery (LAD), right coronary artery (RCA), and intermediate artery.


RESULTS
All patients survived the procedure. A total of seven closed endarterectomies were performed. Five of these were done on LAD and the other two were done on RCA and intermediate artery. Two patients (40%) received inotropic support. One patient had perioperative infarction (20%). Mean follow-up period was 14.2 months +/- 19.7 (range, 1 month to 48 months). All patients were free of angina according to Canadian Cardiovascular Society and were in class NYHA I or II except one, who was in class III. Postoperative catheterization showed that all bypasses to endarterectomized arteries were patent. Patency rate was 83.4%. The mean postoperative ejection fraction was 29.8 +/- 6.9, which was not significantly different from preoperative one (p= 0.12).


CONCLUSIONS
Performing endarterectomy on beating heart in patients with compromised left ventricle is not an easy task. But it can be done with difficulty. Although the procedure is associated with high incidence of infarction, our early results, follow-up clinical status, and graft patency justify its use among patients with compromised left ventricular function who were previously considered inoperable.
Darwazah
Ahmad K
AK
Department of Cardiac Surgery, Makassed Hopital, Mount of Olives, Jerusalem, Israel. darwaz30@hotmail.com
Abu Sham'a
Raed A H
RA
Yasin
Izzedein H
IH
D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications*