Abstract Background: Most cardiac surgeons did not prefer to do CE because it has a higher incidence of surgical morbidities, like postoperative myocardial infarction. Aim of Study: Evaluation of the myocardial muscle per-formance after an endarterectomy procedure in a totally chronic totally occluded LAD. Patients and Methods: Between September 2018 and September 2021, 29 patients underwent closed endarterectomy with only patch anastomosis to the LAD with LIMA. Started Warfarin and Aspirin immediately after there was no bleeding from the chest drains. Echocardiography assessment of EF after six months of surgery. Results: The preoperative echocardiography was improved to 50±6.67 from 45±8.24 after 6 months of surgery. Conclusion: Endarterectomy is a viable alternative to conventional CABG in CTO LAD patients.