J.Jpn. Surg. Soc.. 124(4): 348-352, 2023

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Feature topic

CURRENT STATUS AND FUTURE DIRECTION OF SURGICAL MANAGEMENT WITH CORONARY ENDARTERECTOMY

In addition to advanced age and increased comorbidities, such as diabetes or dyslipidemia, the progressive application of percutaneous coronary intervention increases complex coronary artery disease or diffusely diseased coronary artery in patients presenting for surgical revascularization. Especially, in a diffusely diseased coronary artery, a distal anastomosis to a normal segment is frequently difficult to perform. In the left anterior descending artery (LAD) in particular, a simple anastomosis to the distal LAD does not achieve complete revascularization of the myocardium supplied by the side branches such as diagonal and septal branches. In these cases, coronary endarterectomy can be an effective surgical option. We have consistently performed direct vision endarterectomy of diffusely diseased LAD by using the off-pump technique whenever feasible. The postoperative results in recent years have been excellent. The number of cases requiring this procedure is expected to increase with the severity of the disease in the future.

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