Touch the Plaque Open Technique of LAD Endarterectomy During CABG Surgery Guarantees Fair Postoperative Outcome and Preserved LV Functional Performance

Abstract
Background: The rising number of severely diffused diseased left anterior descending (LAD) coronary artery (which is the most important target) met during coronary artery bypass grafting (CABG) surgeries represents a chal-lenging test to the cardiac surgeon and requires a more complex maneuvers rather than simple distal segment arteriotomy anastmosis in order to secure complete myocardial revascu-larization which is the main goal of the surgery. Touch the plaque open technique of LAD endarterectomy combined with left internal thoracic (mammary) artery (LIMA) patch plasty is one of the available solutions.
Aim of Study: Impact of application of touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty on the postoperative outcome, left ventricular (LV) function and clinical status of the patients is evaluated.
Patients and Methods: This retrospective observational non-randomized study included 21 patients who presented with ischemic heart disease (IHD) requiring primary surgical myocardial revascularization (primary CABG surgery). In-cluded patients are those with multi-vessel coronary artery disease, left main or left main-equivalent coronary artery disease and one or two coronary artery disease. They had anginal pain grade III according to Canadian Cardiovascular Society (CCS) grading of angina pectoris. Intraoperatively they had long segment-diffusely diseased LAD that was dealt with touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty. Postoperative mortality, morbidity outcomes, LV function, overall hospital complica-tions, haemodynamic and functional clinical status, and overall one-year survival were evaluated.
Results: Mean age was 58.23±7.54 years. Female patients represented 42.85%. The overall hospital complication rate was 28.57%. No mortality happened during the follow-up period (overall one-year survival rate was 100%). Preoperative mean LVEF% was 46.3±3.7% (range 37-59%). Evident im-provement in both clinical status and LVEF% was observed. Prior-to-hospital discharge LVEF% showed mild improvement with a mean 50.1±1.3% (p>0.05) and at one-year follow-up showed significant improvement with a mean 57.5±3.4% (p<0.05). 85.71% were in CCS grade I at one-year follow-up (p<0.01).
Conclusion: Touch the plaque open technique of LAD endarterectomy combined with LIMA patch plasty provides satisfactory operative and postoperative results without adding more burden to the surgery. It secures complete revasculari-zation of the LAD myocardial territory and improvement of the LV function and resultant improvement of the clinical and haemodynamic status of the patients. Utilization of LIMA patch plasty and strict anticoagulation management postoper-atively is highly recommended.