Coronary artery reconstruction for extensive coronary disease: 108 patients and two year follow-up
J A Barra1, E Bezon, P Mondine
1Service de Chirurgie Cardiaque, Thoracique et Vasculaire, CHU Hôpital de la Cavale Blanche, Brest, France. jean-aubert-BARRA@wanadoo.fr
Insights
This surgical technique for diffuse coronary artery disease shows promising results, achieving high graft patency and significantly reducing angina symptoms in most patients after revascularization.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Diffuse coronary artery disease presents a significant challenge for traditional revascularization methods.
- Surgical coronary artery reconstruction offers a potential solution for complex cases.
Purpose of the Study:
- To describe and assess a surgical technique for coronary artery reconstruction in patients with diffuse disease.
- Evaluate the efficacy and safety of this novel surgical approach.
Main Methods:
- The technique involves a long arteriotomy, use of internal thoracic artery grafts, and exclusion of atheromatous plaques.
- 118 reconstructions were performed in 108 patients with a mean age of 59, addressing various coronary arteries.
Main Results:
- Perioperative mortality was 3.7%, and myocardial infarction occurred in 6.3% of patients.
- At a mean follow-up of 29 months, 90 patients were free from angina and cardiac events.
- Angiography showed 94.6% patency for internal thoracic artery grafts, with 70 reconstructions patent without restenosis.
Conclusions:
- This surgical coronary artery reconstruction technique effectively revascularizes severely and diffusely diseased coronary arteries.
- The encouraging results suggest this method is a viable option for complex coronary artery disease management.
Background:
Surgical coronary artery reconstruction for diffuse coronary disease is described and assessed.
Methods:
A long arteriotomy, internal thoracic artery graft, and exclusion of atheromatous plaques from the coronary lumen are the bases of the technique. One hundred eighteen reconstructions were performed in 108 patients with a mean age of 59 years. Stable angina was present in 62% of patients and unstable angina in 22%. Sixteen percent had had a recent myocardial infarction. The reconstructions involved 94 left anterior descending coronary arteries, 17 marginal, 5 diagonal, and 2 right coronary arteries.
Results:
The perioperative mortality rate was 3.7% (4 patients). The rate of perioperative myocardial infarction was 6.3%. Mean follow-up was 29 months (standard deviation, 10 months). Two patients were lost to follow-up. Ninety patients were free from angina and cardiac-related events. Five patients sustained a myocardial infarction, 3 were in congestive heart failure, 3 had class II angina, and 1 died of stroke. Seventy-four of the surgical coronary artery reconstructions have been angiographically evaluated (29 months): 94.6% of the internal thoracic artery grafts were completely patent, and 70 of the reconstructions were patent without restenosis. String signs and occlusions were present in two internal thoracic arteries each.
Conclusions:
This technique allows revascularization of severely and diffusely diseased coronary arteries with encouraging results.
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