Coronary Endarterectomy
On Beating Heart
Feasibility And Experience
Vijay Dikshit, Sanjay Kumar, Sanjeev Khulbey,
Apollo Hospitals,
Hyderabad
Introduction
• Coronary endarterectomy continues to be a
controversial technique
• Endarterectomy is considered to be an impediment
for Off Pump CABG
• With some technical modification endarterectomy is
possible for most coronary branches with Off Pump
CABG.
Off Pump Endartrectomy Of Individual
Coronary Branches
Off Pump Cx (OM) Endarterectomy
Technique of Off Pump Coronary
Endarterectomy
RCA &Cx
• Closed technique
- Large arteriotomy
- Plaque dissection
-`Push’ on distal artery
LAD
• Open technique
- Long patch arterioplasty using IMA & SVG
Technical difficulty
• Exposure and stabilisation of long
segment of coronary arteries
• Haemostasis
• Non availability of long shunts and
occluder
Antiplatelet protocol
• Clopidogril 150 mg in the immediate post
operative period
• Aspirin + Clopidogril from 1st POD
Conclusion
• Need for endarterectomy is not an indication for
conversion to cardiopulmonary bypass
• With little technical modifications endarterectomy
of most coronary branches can be safely done
with off pump technique
Thank You