Comparative Outcomes of Closed RCA Endarterectomy and Open LAD Endarterectomy with LIMA Patch Plasty

Introduction: Coronary endarterectomy (CE) is an adjunctive technique used to achieve complete revascularization in patients with diffuse coronary artery disease when conventional bypass grafting is not feasible. To compare early outcomes and graft patency between closed right coronary artery (RCA) endarterectomy and open left anterior descending (LAD) endarterectomy with left internal mammary artery (LIMA) patch plasty.
Methods: This retrospective study included 31 patients undergoing closed traction RCA endarterectomy and 36 patients undergoing open LAD endarterectomy with LIMA patch plasty during CABG. Perioperative outcomes, postoperative arrhythmias, and follow-up coronary angiographic findings were analyzed.
Results: Early mortality occurred only in the closed RCA group but was not statistically significant. Atrial fibrillation rates were similar. The closed RCA group demonstrated significantly higher postoperative bleeding, greater inotropic and intra-aortic balloon pump requirements, longer ICU stay, and more frequent ventricular arrhythmias. Follow-up angiography at a mean of 6.08 ± 2.01 years (open LAD) and 4.21 ± 1.12 years (closed RCA) showed significantly higher anastomotic patency in the open LAD group (94.1% vs. 50.0%, p = 0.008).
Conclusion: Open LAD endarterectomy with LIMA patch plasty provides a more stable early postoperative course and superior mid-term graft patency compared with closed RCA endarterectomy.