Early outcome of coronary endarterectomy combined with coronary artery bypass grafting among patients with coronary artery disease.

Background & Objective: Diffuse coronary artery disease (CAD) poses significant challenges for coronary artery bypass grafting (CABG), particularly when distal targets are heavily calcified. Coronary endarterectomy (CE) allows plaque removal and complete revascularisation, yet evidence on early outcomes remains limited in low- and middle-income countries (LMIC). This study aimed to evaluate 30-day outcomes of CE with CABG. Methodology: We conducted a retrospective review of adults who underwent isolated CABG with adjunctive CE at a high-volume tertiary centre between January 1995 and December 2021. Results: Eighty patients were included, with a mean age of 58 years and 90% were male. Mean body mass index (BMI) was 27.4, and mean ejection fraction (EF) was 48.5%. Median bypass time was 125 minutes and cross-clamp time 87 minutes. CE was most commonly performed on the left anterior descending artery (51%) and right coronary/posterior descending artery (41%). Left main disease >50% was present in 26.3%, and 91% had three-vessel disease. Recent myocardial infarction was noted in 22.5% within seven days and 36.3% beyond seven days. Most common early complications included prolonged ventilation (> 48 hours post-op) (12.5%), re-exploration (5%), and pneumonia (3.8%). About 17% required cardiac intensive care unit stay beyond 48 hours, and 53.8% received blood transfusion. Median hospital stay was six days. Operative mortality was defined as mortality during initial hospital stay and was 2.5%, with no strokes observed. Conclusions: Adjunctive CE during isolated CABG achieved acceptable early outcomes and low mortality in this LMIC setting. The findings support its role as a feasible strategy for diffuse CAD, warranting further prospective evaluation of long-term outcomes with propensity matched control group without CE.