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Surgery for chronic total occlusion of the left main stem: a 10-year experience

Raja Parvez Akhtar1, Mumraiz Salik Naqshband, Abdul Rehman Abid

  • 1Cardiac Surgery Department, Punjab Institute of Cardiology, Lahore, Pakistan. rajapakhtar@gmail.com

Asian Cardiovascular & Thoracic Annals
|November 18, 2009
PubMed

Insights

Coronary artery bypass grafting is effective for chronic total occlusion of the left main stem. This study found surgical revascularization to be an appropriate treatment with no operative deaths.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Chronic total occlusion of the left main stem coronary artery is a rare but serious condition.
  • Early diagnosis and intervention are crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the outcomes of coronary artery bypass grafting (CABG) in patients with chronic total occlusion of the left main stem.
  • To assess the safety and efficacy of surgical revascularization for this specific patient group.

Main Methods:

  • Retrospective study analyzing data from June 1998 to June 2008.
  • Included patients with confirmed chronic left main stem total occlusion identified from 67,082 coronary angiograms.
  • Detailed analysis of patient demographics, risk factors, graft types, and perioperative management.

Main Results:

  • 17 cases (0.025%) of chronic left main stem total occlusion were identified.
  • The mean age of patients was 55.32 years, with common risk factors including diabetes, hypertension, and smoking.
  • Surgical revascularization involved 54 grafts (15 arterial, 39 venous); 14 patients had 3-vessel disease, and 3 had 4-vessel disease.
  • Postoperative complications included myocardial infarction (1), transient ischemic attack (1), and atrial fibrillation (2).
  • There were no operative or in-hospital deaths.

Conclusions:

  • Surgical revascularization via CABG is a safe and effective treatment for chronic total occlusion of the left main stem.
  • The study demonstrates favorable outcomes with no mortality in the evaluated cohort.
  • Coronary artery bypass grafting should be considered an appropriate therapeutic option for this rare but critical condition.

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