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Radhakrishnan et al. Vessel Plus 2019;3:36 I http://dx.doi.org/10.20517/2574-1209.2019.23 Page 5 of 8

Table 3. Perioperative complication
Characteristics CABG + CE (n = 87) CABG (n = 75) P value
Deaths
30 - day 1 (1.1%) 1 (1.3%) 1
Late 4 (4.5%) 3 (4%) 0.7
Complications
Low cardiac output 2 (2.3%) 1 (1.3%) 0.6
Arrhythmia’s 3 (3.4%) 2 (2.6%) 1
Permanent stroke 1 (1.1%) 0 1
TIA 3 (3.4%) 1 (1.3%) 1
Chest infection 1 (1.1%) 2 (2.6%) 0.5
Prolonged ventilation 4 (4.5%) 2 (2.6%) 0.3
Renal impairment 2 (2.3%) 1 (1.3%) 0.6
GI bleed 0 1 (1.3%) 1
Leg wound infection 1 (1.1%) 1 (1.3%) 1
Re-operation for bleeding 4 (4.5%) 1 (1.3%) 0.3
CABG: coronary artery bypass grafts; LCAE: left coronary artery endarterectomy; GI: gastrointestinal; TIA: transient ischaemic attack

Table 4. Hospital resource utilization
Category CABG + CE (n = 87) CABG (n = 75)
post-op ventilation hours 6.96 (2-32) 7.01 (2-15)
ICU stay in days 0.37 (0-14) 0.13 (0-3)
Length of hospital stay in days 6.67 (2-19) 5.58 (3-11)
Blood transfusion (mL) 458 (0-4,134) 308 (0-2,137)
CABG: coronary artery bypass grafts; ICU: intensive care unit; LCAE: left coronary artery endarterectomy

in the CABG group. The deaths in the LCAE group occurred after three years in 2 patients and four years
in the other two patients. The three deaths in the CABG only group occurred after 2 years, 4 years and five
years respectively. The one-year survival was 98.9%, and the 5-year survival was 95.5% in the LCAE group
[Figure 2].

The freedom from angina was similar in both groups at the end of one year, as shown in Figure 3. There
was no statistical difference in the incidence of angina in the post-op period at the end of 10 years follow up.

DISCUSSION
Despite the excellent results obtained with surgical revascularization, advances in the field of PCI coupled
with its less invasive nature have made it the most common interventional treatment strategy for coronary
artery disease [16,17] . However, patients with complex and diffuse disease may be challenging to entirely
surgically revascularize. Complete revascularisation and in particular arterial grafting to the left coronary
system has a significant impact on long term survival of patients [18,19] . It is, therefore, essential for surgeons
to have an effective strategy for grafting patients with diffuse severe obstructive CAD to achieve complete
revascularization. In the presence of diffuse disease, open endarterectomy is a surgical adjunct, which can
produce good clinical results in these otherwise inoperable patients.

Various methods of coronary endarterectomy have been described. Initially, a closed traction method
with primary closure of the arteriotomy was practised . Over time the procedure evolved to include
[1]
patch closure of the arteriotomy combined with LIMA or saphenous vein bypass grafting [6,7,20,21] . In this
study, all endarterectomies were performed under direct vision, exposing the whole arterial lumen and
side branches and arteriotomy closure with vein patch with subsequent end to side grafting was done in
all patients. This has been an effective method, with only one patient requiring further revascularisation