الفهرس 
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Abstract
Background: The diffusely diseased left anterior descending coronary artery (LAD) continues to represent a major challenge for both cardiac surgeons and interventional cardiologists. We evaluated the clinical and early results of this procedure in patients with diffusely diseased left anterior descending artery to clarify the quality of coronary endarterectomy (CE). Forty patients underwent coronary artery bypass grafting (CABG) between September 2019 and September 2020; they were prospectively reviewed and divided into 2 groups; CE with long arteriotomies and on-lay patch bypass grafting (group A) and CE with the conventional pull-out method (group B). Early outcomes over a period of one week, one month and six months were compared between the two groups and analyzed in accordance with the LAD CE method.
Results: Twenty patients in group A were compared with 20 patients in group B and early mortality was 10% for each group, while late mortality was 5% for each group. The mean bypass time in group A was 75.50 ± 13.33 vs. 72.50 ± 13.09 in group B, mean cross clamp time was (54.25 ± 12.38 vs. 53.25 ± 13.11), one patient in group A needed IABP intraoperative but no one in group B needed it, early hospital outcomes during first week in terms of postoperative AF was (20% vs. 15%), postoperative MI (5% in each group), mediastinitis (5% in each group), re-exploration for bleeding (10% vs. 5%) and angina (10% vs. 5%) without any statistically significant differences between both group. After one month follow up; one patient (5%) also in each group experienced recurrence of typical chest pain (NS). The six months follow up ECHO results for all living patients revealed mean ejection fraction (EF) of 56.94 ± 4.41 in group A and 57.12 ± 2.89 in group B with statistically significant difference between preoperative and postoperative EF for each group (P<0.001).
Conclusion: This study indicates that CE can be carried out with an acceptable operative risk and is a safe procedure when done by experienced surgeons with no statistically significant differences between the two groups regarding the early outcomes, so; the method of endarterectomy did not influence the results in this study