Mammary artery patch reconstruction of left anterior descending coronary artery
Anil D Prabhu1, Ismail E Thazhkuni, Sunil Rajendran
1MIMS Institute of Cardiac Sciences, Calicut, India.
Insights
Patch angioplasty using the internal mammary artery offers a safe and effective alternative to coronary endarterectomy for diffuse coronary disease. This off-pump technique demonstrates excellent early and intermediate outcomes with low morbidity and mortality.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease often requires revascularization, with endarterectomy being a common but high-risk procedure.
- High morbidity and mortality associated with traditional coronary endarterectomy necessitate alternative surgical approaches.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump arterial patch reconstruction using the left internal mammary artery for left anterior descending coronary artery disease.
- To assess early and intermediate clinical outcomes and graft patency rates.
Main Methods:
- Retrospective evaluation of 104 patients undergoing off-pump left anterior descending coronary artery reconstruction.
- Utilized in-situ left internal mammary artery as an onlay patch without endarterectomy.
- Assessed perioperative outcomes, hospital stay, and 1-year functional status; follow-up angiography performed in a subset of patients.
Main Results:
- Low mortality (0.9%) and perioperative myocardial infarction rate (1.8%).
- Minimal blood loss (224 mL), short intensive care unit (2.5 days) and hospital stays (7.8 days).
- Excellent 1-year functional outcomes (most patients NYHA class I) and good graft patency on angiography.
Conclusions:
- Off-pump arterial patch reconstruction of the left anterior descending coronary artery is a safe and effective procedure.
- This technique offers excellent early and intermediate results, representing a viable alternative to coronary endarterectomy.
- The use of the internal mammary artery as a patch provides durable revascularization with favorable patient outcomes.
Abstract:
Most patients with diffuse coronary disease require endarterectomy for revascularization. In view of the high morbidity and mortality associated with coronary endarterectomy, patch angioplasty and reconstruction of the coronary artery was developed. We retrospectively evaluated 104 patients who underwent mammary artery patch angioplasty of the left anterior descending coronary artery. The procedure consisted of laying open the entire diseased segment of the coronary artery and patching it with an in-situ left internal mammary artery onlay patch, without endarterectomy, in an off-pump procedure. One (0.9%) patient died, 2 (1.8%) suffered perioperative myocardial infarction, and an intraaortic balloon pump was used in 2. The mean blood loss was 224 mL. Intensive care unit stay was 2.5 days, and hospital stay was 7.8 days. At 1-year follow-up, most patients were in New York Heart Association functional class I. Follow-up angiography was carried out in 16 patients and showed good patency of all anastomoses. Arterial patch reconstruction of the left anterior descending coronary artery can be performed safely and effectively in an off-pump procedure, with excellent early and intermediate results.
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