A Comparative Study to Assess Early Outcome of Reconstructing Diffusely Diseased Left Anterior Descending Artery with and without Endarterectomy.

Abstract

Background: The diffusely diseased left anterior descending coronary artery remains a challenge for both cardiologists and cardiac surgeons. We aimed to compare outcomes of surgical reconstruction of extensively diseased LAD with and without endarterectomy. Patients and Methods: This prospective comparative clinical study included 100 patients. They had diffusely diseased left anterior descending artery and attended our clinic in Suez Canal University hospital between March 2021 and February 2022. Group-A: 50-patients had LAD artery reconstruction with endarterectomy. Group-B: 50-patients had reconstruction without endarterectomy. Results: No significant differences between the study groups regarding age, sex, smoking, family history and comorbidities. Pre-operative clinical and laboratory findings. pre-operative echocardiography and ECG findings. Among Group-A: Inotropes and Intra-aortic balloon pump were more frequently indicated, and Cardio-pulmonary bypass time, Cross-clamp and Operation times were longer, Also, post-operative ventilation-time, respiratory complications, Intensive-care unit-stay, and hospital-stay were statistically significant higher, mortality was higher than in Group-B. Among Group-B: Wound infection and stroke were more frequent. The 6-months follow-up: The presence of angina and dyspnea, Ejection Fraction, End-Diastolic and End-systolic Diameters, and Wall-motion Abnormality showed no significant differences between the two groups. Chest pain and dyspnea were significantly reduced, Ejection-Fraction was higher, End-Diastolic and End-systolic Diameters were less. Only, systolic wall- motion-abnormality showed significant improvement in Group-A. Conclusions: Extensive reconstruction of the diffusely diseased LAD using a re-constructive procedure with or without endarterectomy can be performed safely with a higher rate of complications in the with-endarterectomy group.