title: Early and mid-term results of off-pump endarterectomy of the left anterior descending artery.
abstract: OBJECTIVE
  Many patients referred for coronary artery bypass surgery (CABG) today have diffusely diseased coronary vessels, and some of them may require coronary endarterectomy to provide adequate revascularization. Most reports of coronary endarterectomy describe an on-pump procedure. As off-pump coronary artery bypass graft has become safer and more routine, there is renewed interest in off-pump coronary endarterectomy. We report on our series of patients who underwent off-pump coronary endarterectomy of the left anterior descending (LAD) artery using an open endarterectomy technique.
  
  
  METHODS
  All patients undergoing open heart surgery at The Mount Sinai Medical Center are entered into a state-mandated, audited database. A retrospective review of this database revealed 12 patients between January 2008 and June 2012 who underwent off-pump endarterectomy of the LAD as part of their coronary revascularization. Additional data were collected from a review of the patients' charts.
  
  
  RESULTS
  There were a total of 12 patients, with a mean age of 72 ± 4 years. Nine (75%) were male and 3 (25%) were female. Comorbidities included hypertension in 11 (92%) patients, dyslipidaemia in 10 (83%), diabetes in 8 (67%), renal failure in 6 (50%) and stroke in 1 (8%). The mean number of diseased coronary territories was 3 ± 0.4 (range 2-3), and the mean number of coronary bypass grafts performed was 4 ± 0.8 (range 2-5). Eight patients required transfusion with packed red blood cells (67%). One (8%) patient was converted from off-pump to on-pump. The mean intensive care unit stay was 3 ± 2.8 (range 1-8 days), and the mean hospital length of stay was 15 ± 13 (range 4-54 days). Postoperative follow-up (mean 24 ± 19 months, range 1-53) is complete, and no ischaemic events have occurred in the early and mid-term follow-up period.
  
  
  CONCLUSIONS
  We conclude that off-pump endarterectomy of the LAD is a viable option for patients with diffuse LAD disease.
authors.affiliation: Department of Cardiothoracic Surgery,  Mount Sinai Medical Center, New York, NY,  USA.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Sunir
authors.initials: S
authors.lastname: Gohil
authors.forename: Bonnie
authors.initials: B
authors.lastname: Tong
authors.forename: Patrick
authors.initials: P
authors.lastname: Lento
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Ramachandra C
authors.initials: RC
authors.lastname: Reddy
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome