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Ann Thorac Surg 1988;46:289-296
© 1988 The Society of Thoracic Surgeons

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Articles

Adjunct Endarterectomy of the Left Anterior Descending Coronary Artery

From the Department of Surgery, Section of Cardiac Surgery, Veterans Administration Medical Center, and the Department of Surgery, Georgetown University, Washington, DC, and the Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ

Accepted for publication March 3, 1988.

^* Address reprint requests to Dr. Shapira, VA Medical Center, C.T. Surgery (V112J), 3350 La-Jolla Village Dr, San Diego, CA 92161.

During a three-year period, complete revascularization of diffusely diseased left anterior descending (LAD) coronary arteries was accomplished by extensive endarterectomy in conjunction with bypass grafting in 37 patients in whom conventional bypass was not feasible. This group constituted 7.0% of all patients undergoing nonemergency coronary revascularization during this period. The left internal mammary artery was used to bypass the endarterectomized LAD artery in 22 patients.

There was 1 (2.7%) operative death and 1 perioperative myocardial infarction. At follow-up, which was 100% with a mean of 41.4 months, all endarterectomy patients were in New York Heart Association Functional Class I or II. Twenty-four endarterectomy patients underwent first-pass radionuclide angiographic stress testing 20 months after operation. Twenty patients (83%) had excellent postoperative exercise tolerance, achieving 5 to 7 mets on treadmill testing. Left ventricular functional reserve was preserved, as evidenced by an increase of global ejection fraction from 48 ± 15% at rest to 59 ± 18% (p < 0.005) with exercise. A similar increase was measured in the proximal and distal anterior wall segmental ejection fractions. No difference in response to exercise was found between the internal mammary artery and the vein graft groups. Thus, complete revascularization of the diffusely diseased LAD artery can be accomplished by adjunct endarterectomy without added morbidity or mortality and with excellent functional results.

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