Coronary endarterectomy – A way to complete revascularization

Background and Aim of the Study: Coronary endarterectomy (CE) is performed adjacent to coronary artery bypass grafting (CABG) grafting to aid complete revascularization. However, the purpose of CE in surgical management of diffuse coronary artery disease (CAD) is controversial. The objective of this study was to highlight the operative outcomes, safety, and complications associated with CE. Methods: An observational, prospective research was carried out in the Department of Cardiovascular and Thoracic Surgery at our institute. All patients undergoing isolated CABG + CE from 2019 till 2021 were evaluated. Patients undergoing urgent, emergency, or elective CABG + CE off-pump/on-pump surgery were enrolled. Results: One hundred patients with CABG + CE were evaluated based on symptomatology with sequential electrocardiogram monitoring and blood samples for cardiac biomarkers. The blood samples were taken 6, 12, 24, 48, and 72 h following surgery. Eighty-five patients required single CE and 15 patients required double CE. We noticed a rising trend of cardiac markers in the first 6 h, reaching its peak level at 24 h, and downward trend following 72 h following surgery. Although patients had a tremendous rise in the cardiac biomarker values, clinically patients were stable with operative mortality of 5%. Conclusions: We believe CE helps in complete revascularization in patients with diffuse CAD. CE should be given due consideration in an era where it has been neglected due to its complexities and accompanying myths. CE is an important and integral weapon in a surgeon's armamentarium, and we should not hesitate to perform CE due to associated myths.