Evaluation of different surgical modalities for coronary reconstruction of diffusely diseased left anterior descending artery

Abstract

Aim: Endarterectomy has been shown to be an effective adjunct in treating diffusely diseased coronary arteries. Reconstruction of endarterectomized coronaries has been done by various techniques. We compare early results of left internal mammary artery (LIMA) patch to saphenous vein patch in left anterior descending artery (LAD) reconstruction.

Methods: We prospectively followed 30 patients with diffusely diseased LAD from January 2016 to January 2018. Patients were followed up clinically, by echocardiogram and CT coronary angiography.

Results: Twenty-seven patients were males (90%). The mean age was 59.23 ± 7.98. Twenty-two patients (73.3%) had a LIMA onlay patch. The mean length of patch reconstruction was greater in the saphenous vein group than LIMA group (8.31 ± 1.16 cm vs. 5.64 ± 0.73 cm, P < 0.001). Postoperative myocardial infarction occurred in 1 patient from the LIMA group (4.5%) and 1 patient in the saphenous vein patch group (12.5%). Operative mortality occurred in 1 patient belonging to the LIMA group. Mean time of follow up was 17.59 ± 6.34 months. CT coronary angiography showed a patency rate of 93.1%.

Conclusion: Results of reconstruction by LIMA and saphenous vein patch are comparable in short-term follow up.

Keywords

Endarterectomy / reconstruction / left internal mammary artery patch

References

[1] Garcia S,Roukoz H,Canoniero M.Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies..J Am Coll Cardiol2013;62:1421-31

[2] Bailey CP,Lemmon WM.Survival after coronary endarterectomy in man..J Am Med Assoc1957;164:641-6

[3] Soylu E,Ashrafian H.Does coronary endarterectomy technique affect surgical outcome when combined with coronary artery bypass grafting?.Interact Cardiovasc Thorac Surg2014;19:848-55

[4] Lytle BW,Cosgrove DM,Easley K.Longterm (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts..J Thorac Cardiovasc Surg1985;89:248-58

[5] Baranauskas A,Kibarskis A,Abraitis V.FFR result post PCI is suboptimal in long diffuse coronary artery disease..Eurointervention2016;12:1473-80

[6] Santini F,Lusini M,Barbieri E.Mid-term results after extensive vein patch reconstruction and internal mammary grafting of the diffusely diseased left anterior descending coronary artery..Eur J Cardiothorac Surg2002;21:1020-5

[7] Shapira N,Gottdiener JS,Lemole GM.Adjunct endarterectomy of the left anterior descending coronary artery..Ann Thorac Surg1988;46:289-96

[8] Fundarò P,Santoli C.Coronary endarterectomy combined with vein patch reconstruction and internal mammary artery grafting: experience with 18 patients..Texas Heart Inst J1987;14:389-94 PMCID:PMC324763

[9] FitzGibbon GM,Keon WJ,Kafka HP.Coronary bypass graft fate. Angiographic study of 1,179 vein grafts early, one year, and five years after operation..J Thorac Cardiovasc Surg1986;91:773-8

[10] Lüscher TF,Siebenmann R,Stulz P.Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts..N Engl J Med1988;319:462-7

[11] Barra JA,Mondine P,Gilard M.Coronary artery reconstruction for extensive coronary disease: 108 patients and two year follow-up..Ann Thorac Surg2000;70:1541-5

[12] Gucu A,Yavuz S,Eris C.Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing complete myocardial revascularization..Int J Clin Exp Med2014;7:142-7 PMCID:PMC3902252

[13] Nezic D,Milojevic P,Sagic D.Tandem pedicled internal thoracic artery conduit for sequential grafting of multiple left anterior descending coronary artery lesions..Tex Heart Inst J2006;33:469-72 PMCID:PMC1764961

[14] Owais T,Osama A,Girdauskas E.Early term results of left internal mammary artery patch to left anterior descending artery and left internal mammary artery to on-lay saphenous vein patch in diffusely diseased left anterior descending artery: which is inferior and which is superior?.Int J Cardiovasc Res2016;5:3

[15] Myers PO,Shekar PS,Khalpey ZI.Extensive endarterectomy and reconstruction of the left anterior descending artery: early and late outcomes..J Thorac Cardiovasc Surg2012;143:1336-40

[16] Schmitto JD,Ortmann P,Coskun KO.Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease..J Cardiothorac Surg2009;4:52 PMCID:PMC2756249

[17] Byrne JG,Gudbjartson T,Rawn JD.Left anterior descending coronary endarterectomy: early and late results in 196 consecutive patients..Ann Thorac Surg2004;78:867-73

[18] Sundt TM3rd,Mendeloff EN,Gay WA Jr.Reappraisal of coronary endarterectomy for the treatment of diffuse coronary artery disease..Ann Thorac Surg1999;68:1272-7

[19] Nishi H,Takanashi S,Ishikawa T.Optimal method of coronary endarterectomy for diffusely diseased coronary arteries..Ann Thorac Surg2005;79:846-53

[20] Nishigawa K,Yamazaki M.Ten-year experience of coronary endarterectomy for the diffusely diseased left anterior descending artery..Ann Thorac Surg2017;103:710-6

[21] Takanashi S,Miyamoto Y.Coronary endarterectomy in the left anterior descending artery..J Cardiol2008;52:261-8

[22] Sergeant P,Meyns B.Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important?.J Thorac Cardiovasc Surg1998;116:440-53