Aggressive surgical approach in diffuse coronary artery disease: coronary endarterectomy and early- to mid-term outcomes

Umut Serhat Sanrı, Mehmet Aslan, Dolunay Odabaşı, Özgür Akkaya

Abstract

Aim: In patients with diffuse coronary artery disease (CAD), the absence of a suitable distal target vessel for standard coronary artery bypass grafting (CABG) is the main factor limiting the success of surgical revascularisation. The aim of this study was to evaluate the surgical outcomes, complication profile, and functional recovery of a high-risk patient cohort who underwent single or multiple coronary endarterectomy (CE) concomitantly with CABG in our clinic, in light of the current literature.
Materials and methods: This retrospective single-centre study included 24 patients who underwent isolated CABG combined with single or multiple CE for diffuse CAD between January 2022 and December 2025. Clinical data were collected from hospital records. Patients were evaluated in terms of demographic characteristics, operative variables, blood product usage, postoperative complications, and functional outcomes. Left ventricular ejection fraction (EF) before surgery and at six-month follow-up were compared.
Result: The mean age of the patients was 61 ± 10 years, and 41.7% (n = 10) underwent emergency surgery. A total of 34 coronary artery lesions were treated with endarterectomy in 24 patients (mean 1.41 vessels per patient). Multiple-vessel (two or three vessels) endarterectomy was performed in 33.3% of patients (n = 8). Endarterectomy was most frequently performed in the left anterior descending (LAD) artery (n = 16) and the right coronary artery (RCA) (n = 11). The 30-day mortality rate was 8.3%, and the one-year cumulative survival rate was 91.7%. At postoperative six months, a significant 12% increase in mean EF compared to preoperative values was observed (p < 0.05). However, parallel to procedural complexity, blood product usage was high (mean 4.3 units PRBC, 5.0 units FFP).
Conclusion: In patients undergoing multiple endarterectomies due to diffuse CAD, acceptable mortality rates and significant improvement in left ventricular function can be achieved despite an increased risk of postoperative bleeding. Aggressive revascularisation using the closed technique represents a safe treatment option even when applied to multiple coronary arteries—provided appropriate patient selection is ensured.