Key result
Coronary endarterectomy during LAD reconstruction shows no significant increase in mortality or perioperative MI.
Why the study?
Diffuse coronary artery disease often precludes conventional grafting, and while internal thoracic artery-based reconstruction enables complete revascularization, circumferential or heavily calcified plaques may require adjunctive coronary endarterectomy. This study evaluated the impact of coronary endarterectomy on outcomes following internal thoracic artery-based reconstruction of the LAD.
Does adjunctive coronary endarterectomy impact perioperative myocardial infarction, in-hospital mortality, or long-term survival in patients undergoing internal thoracic artery-based reconstruction for diffuse LAD disease?
Cohort (n=356)
Does adjunctive coronary endarterectomy impact perioperative myocardial infarction, in-hospital mortality, or long-term survival in patients undergoing internal thoracic artery-based reconstruction for diffuse LAD disease?
Answers are grounded in this paper and cite their sources.
In patients with diffuse LAD disease undergoing internal thoracic artery-based reconstruction, selective adjunctive coronary endarterectomy enables complete revascularization of heavily calcified or circumferential plaques without increasing perioperative mortality, myocardial infarction, or impairing 5-year survival.
Objectives Diffuse coronary artery disease often precludes conventional grafting, resulting in incomplete revascularization and poor long-term outcomes. Internal thoracic artery-based coronary artery reconstruction enables complete revascularization for diffuse coronary artery disease. In cases of circumferential or heavily calcified plaques, adjunctive coronary endarterectomy may be required. This study assessed the impact of coronary endarterectomy on outcomes following internal thoracic artery-based coronary artery reconstruction of the left anterior descending artery. Methods Between January 2012 and December 2021, we retrospectively analyzed 356 consecutive patients who underwent internal thoracic artery-based coronary artery reconstruction of the left anterior descending artery. Patients undergoing endarterectomy on coronary arteries other than the LAD or concomitant cardiac procedures were excluded. The cohort was stratified according to coronary endarterectomy use: Group A (with endarterectomy, n=94) and Group S (without endarterectomy, n=262). Primary endpoints were perioperative myocardial infarction and in-hospital mortality. The secondary endpoint was long-term survival. Results Median follow-up was 77 months. Patients requiring coronary endarterectomy had more extensive coronary disease and longer operative times. Despite increased procedural complexity, in-hospital mortality remained low and comparable between groups (2.1% vs 1.9%, p=1.0), as did perioperative myocardial infarction rates (4.3% vs 1.9%, p=0.389). Five-year survival was similar between groups (88.8% vs 86.0%, p=0.592). Conclusions In patients with diffuse left anterior descending artery disease, internal thoracic artery-based coronary reconstruction provides durable revascularization. Within a standardized strategy, selective coronary endarterectomy was not associated with increased perioperative risk or impaired long-term survival.
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Pluchon et al. (2026) conducted a cohort in Diffuse left anterior descending (LAD) coronary artery disease (n=356). Adjunctive coronary endarterectomy during internal thoracic artery-based LAD reconstruction vs. Internal thoracic artery-based LAD reconstruction without coronary endarterectomy was evaluated on In-hospital mortality and perioperative myocardial infarction (p=1.0). Selective coronary endarterectomy during ITA-based LAD reconstruction did not significantly increase in-hospital mortality (2.1% vs 1.9%, p=1.0) or perioperative MI (4.3% vs 1.9%, p=0.389).
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