Surgical management of extensively diseased left anterior descending artery (LAD) is challenging. Reconstruction of the LAD with endarterectomy may lead to intimal disruption and affect the outcomes of surgery. We aimed to compare hospital outcomes of surgical reconstruction of extensively diseased LAD with and without endarterectomy. This retrospective multicenter study included 275 patients who had reconstruction of extensively diseased LAD from 2015 to 2019. We divided patients into two groups: group 1 (n = 138) included patients who had plaque exclusion and patching, and group 2 (n = 137) included patients who had endarterectomy and patching. All patients had primary isolated on-pump coronary artery bypass grafting with the left internal mammary artery (LIMA) grafting to LAD. On-lay LIMA patch was used in 118 patients in group 1 and 132 patients in group 2. A saphenous vein patch was used in 20 patients in group 1 and 5 patients in group 2. Propensity score matching identified 100 matched pairs. The age in group 1 was 56.1 ± 7.8 years versus 55.2 ± 7.1 in group 2 (P = 0.34). There were 119 (86.2%) males in group 1 and 113 (82.5%) in group 2 (P = 0.39). After matching, there was no difference in preoperative and operative data. In the matched groups, low cardiac output occurred in 6 (6%) patients in group 1 and 4 (4%) patients in group 2 (P = 0.73). There was no difference in mechanical ventilation time between groups (9 (25th- 75th percentiles: 7.5–14) hours in group 1 vs. 9 (7–14) hours in groups 2; P = 0.93). Length of hospital stay was 7 (6–9) days in group 1 and 7 (6–10) days in group 2 (P = 0.57). Mortality occurred in one patient in group 1. We did not report early graft occlusion cases in group 1, and one patient had a myocardial infarction in group 2. The outcomes after reconstructing extensively diseased LAD with endarterectomy or plaque exclusion and patching are satisfactory and comparable in both approaches.

中文翻译：

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广泛病变左前降支重建术或不进行内膜切除术的短期结果：倾向评分分析

疾病严重的左前降支动脉（LAD）的外科治疗具有挑战性。内膜切除术重建LAD可能导致内膜破裂并影响手术结果。我们的目的是比较有无内膜切除术的大病LAD手术重建的医院结果。这项回顾性多中心研究纳入了2015年至2019年患有重症LAD重建的275例患者。我们将患者分为两组：第1组（n = 138）包括斑块排除和修补的患者，第2组（n = 137）包括接受动脉内膜切除术和修补术的患者。所有患者均进行了原发的单纯泵上冠状动脉搭桥术，左乳内动脉（LIMA）移植至LAD。在第1组的118例患者和第2组的132例患者中使用了LIMA贴片。在第1组的20例患者和第2组的5例患者中使用了隐静脉贴片。倾向评分匹配确定了100对匹配。第一组的年龄为56.1±7.8岁，而第二组的年龄为55.2±7.1（P = 0.34）。第一组的男性为119（86.2％），第二组的男性为113（82.5％）（P = 0.39）。匹配后，术前和手术数据无差异。在配对组中，第1组的6名患者（6％）和第2组的4名患者（4％）发生低心排血（P = 0.73）。各组之间的机械通气时间没有差异（第1组为9（25％至75％）；第2组为9（7-14）小时； P = 0.93）。第一组的住院时间为7（6–9）天，第二组的为7（6–10）天（P = 0.57）。