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Coronary Endarterectomy

  • Nikolaos A. PapakonstantinouEmail author
Chapter
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Abstract

Complete myocardial revascularization is the ultimate goal of coronary artery bypass grafting. Coronary endarterectomy expands the scope of coronary artery bypass grafting by removing the coronary atherosclerotic core through an arteriotomy in order to achieve complete revascularization. However, there is a lack of guidelines regarding indications of coronary endarterectomy. Despite its promising potential for complete revascularization in diffuse coronary artery disease, increased perioperative myocardial infarction and mortality rates are reported. However, incomplete revascularization after conventional coronary artery bypass grafting due to diffuse coronary artery disease also results in high morbidity and mortality rates. Moreover, the presence of more comorbidities and risk factors in coronary endarterectomy candidates is more likely to be the reason why higher mortality rates are observed rather than the endarterectomy approach itself. Therefore, coronary endarterectomy should be considered whenever complete myocardial revascularization is not otherwise achievable. Diffuse coronary artery disease affecting side branches, severe calcification preventing from a simple coronary anastomosis and in stent restenosis following full-metal jacket procedures may justify performing coronary endarterectomy. However, it is a technically demanding procedure. Consequently, it should only be performed by highly experienced surgeons in a highly selected group of patients when there is no other choice for achieving complete revascularization.

Keywords

Coronary endarterectomy Complete revascularization Diffuse coronary artery disease Diffuse coronary calcification Residual ischemia 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiovascular and Thoracic SurgeryGeneral Hospital of Athens “Evangelismos”AthensGreece

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