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Isolated left main coronary artery stenosis: long term follow up in 106 patients after surgery
F Revault d'Allonnes1, H Corbineau, H Le Breton
1Department of Cardiology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France. jean-claude.daubert@CHU-Rennes.fr
Insights
Surgical revascularization offers a good long-term prognosis for patients with isolated left main coronary artery (LMCA) stenosis. Most patients experience symptom relief and improved survival rates post-surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Left main coronary artery (LMCA) stenosis is a critical condition requiring effective treatment.
- Surgical revascularization remains a primary therapeutic option for LMCA stenosis.
- Understanding the long-term prognosis after surgery is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with isolated left main coronary artery (LMCA) stenosis after surgical revascularization.
- To assess survival rates, symptom relief, and return to work in this patient cohort.
Main Methods:
- A retrospective analysis of 106 patients who underwent surgical revascularization for LMCA stenosis between 1982 and 1998.
- Data collected included patient demographics, preoperative symptoms, surgical details (e.g., number of grafts, internal thoracic artery use), and postoperative outcomes.
- Specific attention was given to patients with ostial LMCA stenosis.
Main Results:
- Early postoperative mortality was 4.7%, with a 5-year survival rate of 86.8%.
- Late mortality occurred in nine cases, with three linked to coronary conditions.
- Among long-term survivors, 81.5% were symptom-free, and 77% of working-age patients returned to work.
- Outcomes for isolated ostial LMCA stenosis were comparable to other LMCA stenosis locations.
Conclusions:
- Surgical revascularization provides a favorable long-term prognosis for patients with isolated LMCA stenosis.
- The procedure is associated with good survival rates and significant symptom improvement.
- Ostial LMCA stenosis does not appear to confer a worse prognosis compared to other LMCA stenosis sites.
Objective:
To analyse the long term prognosis in patients with isolated stenoses of the left main coronary artery (LMCA) following surgical revascularisation.
Patients:
106 patients (71 men and 35 women, mean age 61 years) were operated on between 1982 and 1998. Before surgery, 103 patients presented with angina pectoris and only 10 had a history of myocardial infarction. Their mean left ventricular ejection fraction was 62%. Stenoses were localised on the LMCA ostium in 19 patients, a subgroup characterised by a high proportion of women (68%). Three patients presented with chronic LMCA occlusion. Forty six patients were operated on as an emergency. The mean (SD) number of grafts per patient was 2.0 (0.5), and only one patient had no left anterior descending (LAD) coronary artery bypass. Bypass of the LAD using the internal thoracic artery was performed in 88 cases.
Results:
Early postoperative mortality was 4.7% and the five year survival was 86.8%. Late mortality occurred in nine cases, and in three of these it was linked to a coronary condition. Of the 92 long term survivors, 81.5% were totally symptom-free and 77% of those of working age were able to resume work. The postoperative outcome of patients with isolated ostial LMCA stenosis did not differ significantly from that of the other patients.
Conclusions:
The postoperative prognosis of isolated LMCA stenosis appears good in terms of mortality and symptoms.