Name of the Procedure:

Coronary Endarterectomy, Open, Any Method, of Left Anterior Descending, Circumflex, or Right Coronary Artery (Performed in Conjunction with Coronary Artery Bypass Graft Procedure, Each Vessel)

Summary

Coronary endarterectomy is a surgical procedure that involves the removal of atherosclerotic plaque buildup from the major coronary arteries. It is commonly performed in conjunction with a coronary artery bypass graft (CABG) surgery to improve blood flow to the heart.

Purpose

The procedure addresses coronary artery disease, which is the narrowing or blockage of coronary arteries due to plaque buildup. The goal is to restore normal blood flow to the heart, alleviate symptoms such as chest pain, and reduce the risk of heart attacks.

Indications

• Symptoms of coronary artery disease, such as chest pain (angina) or shortness of breath.
• Significant blockage in the left anterior descending, circumflex, or right coronary artery.
• Patients who are candidates for coronary artery bypass graft (CABG) surgery and require additional plaque removal.

Preparation

• Patients may need to fast for several hours before the surgery.
• Medications may need adjustment, particularly blood thinners.
• Preoperative tests may include blood tests, electrocardiograms (EKG), and imaging studies like coronary angiograms.

Procedure Description

1. The patient is placed under general anesthesia.
2. A chest incision is made to access the heart and coronary arteries.
3. The affected coronary artery is opened, and specialized surgical tools are used to remove plaque from the artery walls.
4. The artery is then repaired, and in conjunction, a bypass graft is performed to route blood around the blocked section.
5. The chest is closed, and the patient is moved to a recovery area.

Duration

Typically, 3 to 5 hours, depending on the complexity and the number of vessels treated.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (if cardiopulmonary bypass is used)
• Surgical Technicians

Risks and Complications

• Bleeding or infection at the incision site.
• Blood clots or stroke.
• Heart attack or irregular heart rhythms.
• Complications related to anesthesia.
• Re-narrowing of the artery (restenosis).

Benefits

• Improved blood flow to the heart.
• Relief from symptoms of coronary artery disease.
• Reduced risk of future heart attacks.
• Enhanced quality of life.

Recovery

• Initial recovery in the intensive care unit (ICU) for close monitoring.
• Hospital stay of about 5 to 7 days.
• At-home recovery may take several weeks to months.
• Restrictions on physical activities, with gradual reintroduction.
• Follow-up appointments for monitoring and cardiac rehabilitation.

Alternatives

• Percutaneous coronary intervention (angioplasty with stent placement).
• Medical management with medications (e.g., statins, beta-blockers).
• Lifestyle modifications (diet, exercise, smoking cessation).

Pros of endarterectomy: Direct removal of plaque; effective in severe cases. Cons of alternatives: Potential for incomplete relief of symptoms; possible need for repeat procedures.

Patient Experience

• During the procedure, patients are fully asleep and feel no pain.
• Post-procedure: possible soreness at the incision site; fatigue as the body recovers.
• Pain management with medications, and gradual reintroduction to daily activities.