Dealing with Heavy Atherosclerotic Burden in the Left Anterior Descending Artery with Coronary Endarterectomy or Onlay Patch Angioplasty - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Ohad Bitan ¹ Eyal Leshem ¹ Paul Pirundini ² Carrie Consalvi ² Kevin Lilly ² Quincy King ² Dan Loberman ²

¹Department of Medicine C, Sheba Medical Center at Tel Hashomer, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
²Division of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

Objectives: Coronary endarterectomy has been shown to be an effective adjunct to surgical revascularization in treating patients with severe coronary lesions. In some patients, treating heavy atherosclerosis in the left anterior descending artery (LAD) is also possible with a long arteriotomy and onlay patch angioplasty without an endarterectomy. The aim of this study is to review short and long term outcomes of these two different surgical techniques.

Methods: We retrospectively reviewed 164 patients who underwent endarterectomy or onlay patch angioplasty to the LAD between August 2002 and December 2014. 94 patients (group A) had LAD endarterectomy and 70 patients (group B) underwent onlay patch angioplasty. We compared the early and late outcomes of these two groups.

Results: The mean age was 71 and 67 in groups A and B, respectively. Operative mortality was 3.2% in group A and 2.8% in group B. The incidence of perioperative myocardial infarction was 3.2% and 0% in groups A and B, respectively. The total survival at the end of the follow up period was 71% percent in group A and 86% in group B.

Conclusions: Endarterectomy and patch angioplasty of the LAD as adjunct to CABG are safe and feasible techniques for revascularization of patients with a heavy burden of atherosclerosis in the LAD. The higher morbidity and mortality rates in endarterctomy patients probably reflects the more severe nature of their disease.