title: Extensive endarterectomy and reconstruction of the left anterior descending artery: early and late outcomes.
abstract: OBJECTIVE
  Coronary endarterectomy has been shown to be an effective adjunctive technique of revascularization for diffuse coronary artery disease. A long arteriotomy and reconstruction of the left anterior descending artery (LAD) are occasionally required for complete extraction of the atherosclerotic plaque. The aim of this study was to examine early and late results of this technique and compare 2 different reconstruction methods.
  
  
  METHODS
  We retrospectively reviewed 224 consecutive patients who underwent extensive LAD endarterectomy and reconstruction between January 1992 and March 2010. For reconstruction, 101 patients underwent saphenous vein patch and LAD grafting (group A) and 123 patients had left internal thoracic artery onlay patch grafting (group B). We compared early and late outcomes and assessed the association of the reconstruction method and long-term survival.
  
  
  RESULTS
  The mean age was 66 and 67 years in groups A and B, respectively. Operative mortality was 3.0% and 4.1%, and the incidence of perioperative myocardial infarction in the LAD territory was 4.0% and 4.1% in groups A and B, respectively. There was no significant difference in early operative outcomes (P > .05). Actuarial 5-year survival was 78.6% and 87.1% and 10-year survival was 45.4% and 49.4% in groups A and B, respectively. Cox hazard proportional analysis showed that the reconstruction method did not have a significant impact on long-term survival.
  
  
  CONCLUSIONS
  Extensive LAD endarterectomy and reconstruction is a safe and feasible technique of revascularization for diffuse coronary artery disease. The reconstruction method should be based on the availability of conduits and length of the arteriotomy.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Zain I
authors.initials: ZI
authors.lastname: Khalpey
authors.forename: Sary F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000368:Aged; D001900:Boston; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome