title: Outcomes after a left anterior descending artery endarterectomy in advanced coronary artery disease.
abstract: BACKGROUND
  Coronary endarterectomy albeit infrequently utilized remains a pivotal treatment modality for advanced atherosclerotic heart disease. Benefits of coronary endarterectomy are explored in terms of better mid-term survival, freedom of major adverse cardiac and cerebrovascular events and improved left ventricular ejection fraction.
  
  
  METHODS
  50 patients with coronary artery disease including extensive diffuse LAD disease underwent a left anterior descending artery endarterectomy with coronary by-pass grafting and left internal mammary artery as conduit between 2006 and 2014. Prospective evaluation was performed on an outpatient basis with physical examination, echo recordings of ejection fraction and LAD flow reserve for 24 up to 60months.
  
  
  RESULTS
  Study group was constituted by a male to female ratio 4:1 and mean age 62.4years old. Pre-operative characteristics included patients with age<60years old and gensini score>60 in 42.1% while patients with age>60years old had gensini score (21-60) in 63.4%. Furthermore, males were affected more severely by atherosclerosis than females. Postoperative anterior wall contractility of left ventricle was improved (56% pre-op vs. 66% post-op) and hypokinesis reduced (34% pre-op vs. 24% post-op). No deaths were recorded for a mean follow-up of 48months. Also, MACCE were recorded in 8% patients. Post-operative LAD flow reserve was normal in 66% and reduced in 33% of cases. Finally, gensini score preoperatively affects mid-term flow reserve postoperatively (p<0.05).
  
  
  CONCLUSIONS
  Coronary endarterectomy presents a viable modality that preserves myocardial function and restores LAD flow in patients with diffuse atherosclerotic LAD. Also postoperative adverse effects were minimal while mid-term flow reserve was affected by preoperative factors.
authors.affiliation: 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Katselis
authors.affiliation: 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: gsamanidis@yahoo.gr.
authors.forename: George
authors.initials: G
authors.lastname: Samanidis
authors.affiliation: 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Papasotiriou
authors.affiliation: Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Karatasakis
authors.affiliation: 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Nenekidis
authors.affiliation: Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Eftichia
authors.initials: E
authors.lastname: Demerouti
authors.affiliation: Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Theofani
authors.initials: T
authors.lastname: Antoniou
authors.affiliation: 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Perreas
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods / Q000401:mortality; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Coronary artery bypass grafting; Coronary endarterectomy; Coronary flow reserve