CORONARY ENDARTERECTOMY AND PATCH ANGIOPLASTY FOR DIFFUSE CORONARY ARTERY DISEASE. A PROSPECTIVE ANALYSIS OF 22 CASES

Diffus e cor o n ar y art e r y d i s e a se (C A D ) i sa s u rg i c alcha ll e nge i nwh i chc o nv e ntionalc o ro n ary a r te r y by p as s g r aftin g (C A BG ) ma y n ot a c h i ev e a de quat e my o c a r d ial r ev a s cu l arization u nl e ss adjuvant p r o c edures s uchasc o r o n aryend a rt ere c t o m y an d c o r o na r y p a tc h a ngiop l ast y ( CPA) ar e a d d ed . T h e ai m o f thi s pr o s p e c tiv e s tud y i s t o e v aluat e th e o u t com e o f thes e pr o ced u r e s in ou r i n s titutio n i n vie w o f th e relevan t literature. D at a o f al l patient s w h o un d er w en t C PA ±C A B Gby on es u r g eo n i n o ur i nstitution ( n =22) betw e e n A p r il2018a n d A pril 2 019w e recol l e c ted. P atien t s u nd e rwentop e nc o r o n a ry end a rterect o m y an d on l a y patc h o f lef t i nterna l m a m m aryar t e ry(LIMA)orav e no u spa t ch u nder cardio p u lmo n ar y bypas s (CPB). O f 16 7 C A B G pr o c ed ur e s, 2 2 wer e combin e d wit h C PA . Ther e wer e15 (6 8. 2% ) mal e s . Age ran g e d b etween 4 3 - 7 2yearswitha m eanof 5 9.patients i n c l uded 1 9 i s o l ate d lef t an t eri o r desc e n ding a rteri e s(L A Ds), t wori g ht c oro n a ry a rt e r i esando n e o btus e m a rg i n a lb ra n c h . Th e CPBtime w as8 8 -1 9 8 m i nutesa n d t hea o rt i c c r o sscla m pti m ew a s4 0 - 1 2 5 minut e s. T he patient s h a d (inc l udi n g L A D ) 2- 4 v e sse l dise a s e s. T h e averag e I C U s ta y wa s 2 9 ±1 4 h o ur s a nd meanh o spit a lstayw a s5dayswithnocompl i cati on s ap a rt f r o m atria l fibril l a tio n (n=4 , 18.2%). Thefoll o w- u pperi o dra n g e d f rom4to 1 4mont h s.On t he40thp o stoperativ e d a y ,c oro n ar y CT angi o g r a ph y reveale d p a t e n t grafts . N o patien t die d du e t o CAD. I n c o n c l u s i o n, c oron a r y end a rterect o m y an dan g i op l a s t y i sasa f ea n d h i ghlyr e w a rd i ng pr o c e du r e i n potentiall y inoper a b l e pati e nt s wit h diffu seco r o n ar y arter y di se a s e . K ey w o r d s : C or o na ryar t e ryd i s e ase, e nd ar t erec to m y,a n g io p l as t y ,v e n o us, p a t ch , lef tan t e r i o r desc e n d i n g , lef t i n te r n al m a m mary a r te ry.