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Coronary Endarterectomy of the Left Anterior Descending Artery
In experienced hands, coronary endarterectomy (EA) has been performed with good results. The procedure can facilitate conversion of severe ungraftable disease to a graftable coronary artery, and provide outcomes comparable to CABG. Many surgeons are still reluctant to use coronary EA primarily because of increased mortality and myocardial infarction rate postoperatively compared with CABG alone.
The authors present the case of a 64-year-old man with hypertension, diabetes, and a non-ST elevation myocardial infarction. Cardiac catheterization showed severe 3-vessel coronary artery disease with depressed left ventricular function. Given the extent of the patient’s diffuse coronary disease, surgical intervention was denied at an outside facility and he was managed medically. Due to persistent ongoing angina, the patient was referred to Brigham and Women’s Hospital two months later. The patient subsequently underwent a LAD coronary endarterectomy with CABG x 3. At a 4-month follow up visit, the patient was doing well.
This video demonstrates a long segment left anterior descending coronary endarterectomy with saphenous vein angioplasty and LIMA-LAD. The postoperative anticoagulation protocol from Brigham and Women’s Hospital is also described.
This video is also authored by Luigino Nascimben.