Background: Coronary endarterectomy (CE) is a demanding but valuable adjunct to coronary artery bypass grafting (CABG) for diffuse, calcific coronary artery disease, particularly in resource-limited settings where complete revascularization may otherwise be impossible. Methods: We retrospectively studied 105 consecutive patients who underwent CABG with CE between 2018 and 2024. In total, 137 CEs were performed (135 closed traction, two open patches). Survival was estimated by Kaplan–Meier analysis and censored on July 31, 2025 (mean follow-up 33.1 ± 23.2 months). The primary endpoint was overall survival; secondary endpoints were 30-day major adverse events: stroke, myocardial infarction (MI), heart failure, re-exploration, dialysis, prolonged ventilation/tracheostomy, delirium/psychosis, intensive care unit stay, and operative details. Results: Male predominance was noted (3.8:1). Triple-vessel disease was present in 83.8%, and 3.8% had an ejection fraction <30%. Multivessel CE was required in 41%. Thirty-day mortality was 10.5%, with a further 6.7% late mortality. Perioperative stroke and MI occurred in 1.0% and 2.9%, respectively. All 18 deaths occurred within 195 days; thereafter, survival plateaued. Five-year survival was 82.9%. Closed traction was employed in 98.5%, with open patch angioplasty reserved for heavily calcified arteries. Conclusions: This large single-center Indian experience demonstrates that CE judiciously extends CABG to patients with otherwise ungraftable disease. Despite early hazard, perioperative stroke and MI rates were low, and survivors achieved durable midterm survival. Multicenter registries are needed to refine patient selection and operative strategies.
Lakhote et al. (Thu,) studied this question.