A Single Center Experience with Coronary Endarterectomy and Vein Patch Reconstruction

Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospective review of all coronary artery bypass graft (CABG) procedures performed from January 1, 2000 through June 30, 2013 with and without concomitant coronary endarterectomy (CE), was carried out at the Veterans Affairs Medical Center in Washington DC. Patients who underwent concomitant valve operations were excluded. Primary outcome was overall survival, with analyses performed examining CE as well as the use of cardiopulmonary bypass. Secondary outcomes included 30-day mortality and post-operative MI. Results: 1255 CABG operations were performed, 10 of which included CE. All CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits. 1-year survival was 70%. 5-year survival was 43% out of 7 patients. Conclusions: Pull-through CE with saphenous vein patch is a safe alternative technique for patients with diffuse coronary artery disease. Perioperative events and intermediate outcomes are favorable, although long-term survival is less than patients without CE.