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Radhakrishnan et al. Vessel Plus 2019;3:36 Vessel Plus
DOI: 10.20517/2574-1209.2019.23

Original Article Open Access

Outcomes of long left coronary endarterectomy in
patients with diffuse coronary artery disease

Kamaraj Radhakrishnan , Sean D. Galvin , Adam El-Gamel 1
1
2
1 Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton 3400, New Zealand.
2 Department of Cardiac Surgery, Wellington Regional Hospital, Hamilton 3400, New Zealand.
Correspondence to: Prof. Adam El-Gamel, Department of Cardiothoracic Surgery, Cardiothoracic Surgical Unit, Waikato
Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand. E-mail: elgamela@waikatodhb.govt.nz

How to cite this article: Radhakrishnan K, Galvin SD, El-Gamel A. Outcomes of long left coronary endarterectomy in patients
with diffuse coronary artery disease. Vessel Plus 2019;3:36. http://dx.doi.org/10.20517/2574-1209.2019.23

Received: 8 Jul 2019 First Decision: 2 Aug 2019 Revised: 26 Aug 2019 Accepted: 30 Sep 2019 Published: 24 Oct 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published: x Aim: Historically the outcome of left coronary artery endarterectomy (LCAE) has been associated with increased
morbidity and mortality when surgeons performed it with coronary artery bypass grafting (CABG). We aim to
Science Editor: Copy Editor: Production Editor: Jing Yu
review outcomes after open LCAE-CABG in patients managed with aggressive dual antiplatelet therapy.

Methods: From 1999 to 2007 open LCAE with CABG was performed in 87 patients. We compared the short and
long-terms outcomes of 75 propensity-matched conventional CABG patients. Both groups were operated on by a
single surgeon.

Results: Sixty-six percent (66%; n = 58/87) of LCAE group had diffuse atheroma in Left anterior descending artery
(LAD); 31% (n = 27/87) involved both LAD and branches of the circumflex artery (Cx); 3%; (n = 3/87) involved the
Cx in isolation. Cross clamp time (43.29 vs. 59.04, P = 0.019) and bypass time (57.29 vs. 74.04, P = 0.007) were
significantly higher in the LCAE group. There was no significant difference in early (1% vs. 1.3%) and late mortality
(4% vs. 4.5% at 10 years). The hospital length of stay (5.58 vs. 6.67, P = 0.03), was higher in the LACE group when
compared with the CABG group. The freedom from angina and long-term survival were not significantly different
between the two groups.

Conclusion: Patients undergoing CABG with Left-sided coronary endarterectomy had increased cross-clamp and
bypass times with prolonged stay in hospital and increased blood transfusion rates. The mortality, morbidity, long-
term survival and freedom from angina are not different when compared to CABG alone. The use of retrograde
blood cardioplegia and aggressive antiplatelets may have contributed to the excellent outcome.
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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