Impact of Coronary Endarterectomy on Mid-Term Left Ventricular Functional Recovery in Diffuse Coronary Artery Disease.

PURPOSE: Although coronary endarterectomy performed for diffuse coronary artery disease is known to increase early postoperative morbidity, its effects on mid-term myocardial functional recovery remain controversial. Therefore, this study aimed to examine changes in preoperative and sixth-month postoperative left ventricular ejection fraction, as assessed by echocardiography, in patients undergoing single or multiple coronary endarterectomy concomitantly with coronary artery bypass grafting.

METHODS: A total of 151 patients who underwent coronary artery bypass grafting with concomitant coronary endarterectomy, performed by experienced surgical teams between 2023 and 2025, were included in this retrospective, multicenter cohort study. Early morbidity and mortality were evaluated in the entire cohort of 151 patients, whereas the mid-term changes in echocardiographic left ventricular ejection fraction were examined in the remaining 138 patients after exclusion of the 13 patients who died in the early postoperative period. Recovery dynamics were analyzed according to the number of target vessels undergoing endarterectomy and aortic cross-clamp times.

RESULTS: Endarterectomy was performed on a total of 298 target lesions (mean 1.97 per patient) in the 151 patients included in the study, and multiple vessel endarterectomy was performed in 58.3% of the cases. The mean preoperative left ventricular ejection fraction was 46.6% ± 9.9%, and a clinically significant relative improvement of 16.8% was observed by the end of the sixth postoperative month (p < 0.001). Although multiple endarterectomy procedures and prolonged cross-clamp time tended to increase early morbidity, including postoperative atrial fibrillation and bleeding, no statistically significant difference was detected compared with single procedures (p > 0.05, p = 0.388). In particular, complete revascularization of the left anterior descending artery territory was identified as the strongest predictor of functional recovery.

CONCLUSIONS: Although coronary endarterectomy carries early risks related to increased surgical surface area and prolonged ischemia, it is associated with significant and sustained improvement in mid-term left ventricular functions among surviving patients, likely through reverse remodeling resulting from complete resolution of myocardial hibernation in the ischemic myocardium.