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Mid-term outcome of surgical coronary ostial plasty: our experience
M Bonacchi1, E Prifti, G Giunti
1Istituto di Chirurgia del Cuore e dei Grossi Vasi, Università degli Studi di Roma, La Sapienza, Italy.
Insights
Surgical ostial plasty offers a more physiological alternative to traditional coronary artery bypass grafting for specific coronary artery blockages. This technique shows high success rates and preserves grafting material for future interventions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Conventional coronary artery bypass grafting for left main coronary artery (LMCA) stenosis involves grafts, leading to less physiological myocardial perfusion.
- Coronary ostial plasty is an alternative for proximal obstructive coronary artery disease without calcifications.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical ostial plasty as an alternative to coronary artery bypass grafting for proximal coronary artery stenosis.
Main Methods:
- Surgical ostial plasty using fresh pericardial patches was performed in 23 patients with LMCA or right coronary (RC) ostial stenosis.
- Coronary artery bypass grafting was added in seven cases for distal stenosis.
- Patient outcomes were assessed via myocardial scintigraphy and coronary angiography.
Main Results:
- Overall successful outcome for surgical ostial plasty was 22 of 23 patients.
- Good myocardial perfusion was demonstrated in 21 of 22 patients post-operation.
- Follow-up angiography showed good ostial plasty results in 21 of 22 patients and good coronary flow in 19 of 22.
Conclusions:
- Surgical ostial plasty is a viable alternative for proximal noncalcified obstructive coronary lesions.
- The technique provides more physiological revascularization, spares grafting material, and allows for future interventions.
Abstract:
The conventional coronary artery bypass procedure that uses venous or arterial conduit for isolated critical stenosis of the left main coronary artery (LMCA) restores a less physiological perfusion of the myocardium and uses an appreciable length of bypass material. Coronary ostial plasty has been described as an alternative surgical technique in proximal obstructive coronary artery disease without calcifications. Here we report 23 patients (15 males and 8 females aged 37-78 years; mean age 57 years) who underwent surgical ostial plasty. Ostial reconstruction with fresh pericardial patch was performed in all patients: 15 patients with LMCA stenosis, 6 patients with right coronary (RC) ostial stenosis, and 2 patients with both RC artery and LMCA stenosis. In seven cases, coronary artery bypass grafting was added for contralateral distal stenosis with a total of five arterial conduits and six venous grafts. One patient died; the ostial plasty and grafts were patent at necropsy. Thallium-201 myocardial scintigraphy under stress at 30 days to 6 months after operation demonstrated good myocardial perfusion in 21 of 22 patients. Coronary angiography at follow-up (49 +/- 8 months) demonstrated good surgical ostial plasty results in 21 of 22 patients and good coronary flow in 19 of 22 patients; angiographic study at mid-term follow-up revealed only one failure of the surgical ostial plasty technique associated with venous graft obstruction. In 2 other patients CABG failure due to venous graft obstruction (1 patient) or distal stenotic lesions of the left coronary artery (1 patient) was noted. The overall successful outcome of the surgical ostial plasty was 22 of 23. We believe that surgical angioplasty of the coronary ostia may be used in the presence of proximal noncalcified obstructive lesions as an alternative technique, which offers a more physiological revascularization; it also spares grafting material and allows subsequent percutaneous transluminal angioplasty or coronary artery bypass surgery.