Coronary endarterectomy with beating heart in patients with diffuse atheromatous coronary artery disease and poor ventricular function: early and midterm results.

Background: In this study, we retrospectively reviewed our experience with off-pump coronary artery bypass grafting and coronary artery endarterectomy in patients with severely reduced left ventricular function and diffuse atheromatous coronary artery disease to evaluate the early and midterm results.

Methods: Between July 1998 and March 2004, 42 patients underwent off-pump myocardial revascularization with coronary artery endarterectomy. The mean age (+/-SD) for the 28 male and 14 female patients was 59 +/- 10.2 years. Twenty-seven patients (64.2%) had experienced a previous myocardial infarction, and 11 (26.2%) had undergone an operation on an emergency basis. All patients had an ejection fraction of less than 30%. The left anterior descending coronary artery was the most endarterectomized vessel (75% of patients).

Results: There were 5 early deaths (11%). Twenty-five (67.6%) of the surviving patients were symptom free, and 8 were in Canadian Cardiovascular Society classes II to IV. The ejection fraction improved after the operation in the 30 patients (71.42%) who underwent echocardiographic control and coronary angiography. The 28.4-month patency rate of the endarterectomized coronary arteries was 89%. The patency rates were 93.3% for the left internal thoracic artery-left anterior descending coronary artery and 88.8% for the right coronary artery.

Conclusion: The results of this study show increased operative mortality and morbidity in patients requiring coronary artery endarterectomy. However, the early results and particularly the midterm survival rates, clinical status, and continued graft patency justify off-pump coronary artery endarterectomy in patients with severely depressed left ventricular function and diffuse coronary artery disease. Many of these patients have disease that would otherwise be inoperable.