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Page 6 of 8 Radhakrishnan et al. Vessel Plus 2019;3:36 I http://dx.doi.org/10.20517/2574-1209.2019.23

Figure 2. Survival in patients undergoing CABG only (group 0) or CABG combined with coronary endarterectomy (group 1)

Figure 3. Freedom from angina in patients undergoing CABG only (group 0) or CABG combined with coronary endarterectomy (group 1)

in the immediate post-op period due to poor cardiac output. All patients in the LCAE group had diffuse
severe coronary artery disease. The ability to achieve complete revascularization and where possible to use
the left internal mammary artery (89% of patients in this study) to bypass the left coronary system has been
shown to improve outcomes in patients with CAD. In the LCAE group, complete revascularization likely
would not have been possible without the use of adjuvant coronary endarterectomy. Furthermore, in native
coronary arteries with multiple sequential obstructive lesions, coronary endarterectomy coupled with vein
patching and grafting allows the target vessel to be grafted with a single rather than numerous coronary
anastomoses.

The higher incidence of perioperative myocardial ischemia in earlier studies involving technically excellent
surgeons was not seen in this study [5,9,15] . Two critical factors have likely contributed to improved outcomes
in this compared to historical studies: firstly advances in techniques of myocardial protection, in particular,