Coronary endarterectomy in the current era

Abstract

With the increasing incidence of diffuse coronary artery disease and improving results of coronary endarterectomy, it is vital for cardiac surgeons to have coronary endarterectomy in their armamentarium to achieve complete coronary revascularisation.

Left Anterior Descending Artery Endarterectomy by Hydrodissection

“…Most surgeons preferred doing it on the larger right coronary artery (RCA) as the risks of peri-operative myocardial infarction (MI) were lower than with left anterior descending artery (LAD) CE [1][2][3]. Diffusely diseased LAD remains a challenge for both interventional cardiologists and cardiac surgeons.…”

“…blocked arteries before the advent of the coronary artery bypass grafting (CABG) operation [1]. Most surgeons preferred doing it on the larger right coronary artery (RCA) as the risks of peri-operative myocardial infarction (MI) were lower than with left anterior descending artery (LAD) CE [1][2][3].…”

Coronary Endarterectomy with off Pump Coronary Artery Bypass Surgery- A Review

“…In open methods, a longitudinal incision for coronary arteriotomy is performed distal to the atheromatous plaque and extracted the atheroma from vessel, 21 followed by reconstruction of endarterectomized site with on lay patch either with Internal thoracic artery or a saphenous venous patch. 22,23 However, a longitudinally opened saphenous vein can be used to repair the arteriotomy and thereafter the left internal mammary artery can be anastomosed with the vein patch.…”

“…Till date, there is no standard anticoagulation regimen after coronary endarterectomy exists. 21 Postoperatively, intravenous heparin, 75 mg combination of Aspirin with Clopidogrel, and warfarin are used. Heparin is continued until desired warfarin effect achieved that is INR (International normalized ratio) is 1.5 to 2.5.…”

“…But till now, it is unclear which the perfect procedure is. 21 But there is a common practice between these two strategies to remove atherosclerotic plaque that is an arteriotomy is the basic principle in both methods. 17 …”