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Mid-term results of conventional bypass surgery for complex proximal left anterior descending coronary artery
S Forlani1, C Bassano, F Tomai
1Department of Cardiac Surgery, Tor Vergata University European Hospital, Rome.
Insights
Conventional coronary artery bypass grafting (CABG) offers excellent early and medium-term results for complex left anterior descending (LAD) artery disease, demonstrating a high freedom from cardiac events. This surgical approach remains the gold standard for treating LAD disease when other methods are suboptimal.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Proximal left anterior descending (LAD) coronary artery disease significantly impacts prognosis and requires effective treatment.
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous transluminal coronary angioplasty with stent implantation (PTCA/S) are alternatives to conventional coronary artery bypass grafting (CABG).
- This study evaluates CABG for complex LAD disease where PTCA/S or MIDCAB might yield suboptimal results.
Purpose of the Study:
- To assess the early and medium-term outcomes of conventional CABG in patients with complex LAD disease.
- To compare the efficacy of CABG against less invasive revascularization techniques in specific patient subgroups.
- To establish the safety and effectiveness of CABG as a primary treatment for complex LAD lesions.
Main Methods:
- Retrospective analysis of 100 consecutive patients undergoing isolated CABG for LAD disease.
- Grafting strategies included single or multiple grafts to LAD and diagonal branches.
- Patient selection for CABG was based on predicted suboptimal outcomes with PTCA/S or MIDCAB, study protocols, or patient/cardiologist preference.
Main Results:
- Left internal mammary artery (LIMA) to LAD grafting was performed in 99% of patients; 65% received additional saphenous grafts to diagonal branches.
- No perioperative deaths occurred within 30 days; only one patient (1%) experienced a perioperative myocardial infarction (MI).
- At a mean follow-up of 38 months, no cardiac deaths or new MIs were recorded. Freedom from cardiac events was 99% at 1 year and 86% at 5 years.
Conclusions:
- Conventional CABG is currently the gold standard for treating most cases of LAD disease, offering excellent safety and efficacy.
- The procedure demonstrates favorable early and medium-term freedom from cardiac events.
- Further prospective studies are needed to directly compare CABG with percutaneous transluminal techniques and MIDCAB.
Background:
The significant involvement of proximal left anterior descending (LAD) coronary artery affects patient prognosis and must be treated. Recently, as alternative methods to conventional coronary bypass (CABG), minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous transluminal coronary angioplasty with stent implantation (PTCA/S) have been proposed to reduce costs and patient discomfort. The aim of this study was to obtain early and medium-term results of CABG in patients with complex LAD disease in whom the expected results with PTCA/S or MIDCAB would have been suboptimal.
Methods:
We retrospectively examined one hundred consecutive patients subjected to isolated CABG who received either a single graft to LAD or several grafts to LAD and diagonal branches. The choice of CABG was due to poor expectable results with PTCA/S or MIDCAB because of anatomical characteristics of the lesion, inclusion in ongoing randomized study comparing surgical versus non-surgical revascularization, or preference on the part of the cardiologist or patient.
Results:
Left internal mammary artery (LIMA) was grafted to LAD in 99 (99%) patients; 65 (65%) patients received at least one saphenous graft to the diagonal branches. No death was observed within 30 days from the operation. One (1%) patient had a perioperative non-Q myocardial infarction (MI). At a mean follow-up time of 38 +/- 16 months (range 2-60), there were no cardiac deaths and no new MI. Six patients complained of recurrent angina: in all cases but one (vein graft failure to a diagonal branch), there were no clinical or diagnostic signs suggesting other graft failures. The probability of freedom from early and late events, including cardiac death, MI and recurrence of angina regardless of site, was 99% at 1 year and 86% at 5 years.
Conclusions:
At present, conventional CABG seems to be the "gold standard palliation" of LAD disease in most cases. It can be performed safely with excellent early and medium-term results in terms of freedom from cardiac events. Its comparison with percutaneous transluminal techniques and MIDCAB needs to be addressed in further prospective studies.