Surgery for chronic total occlusion of the left main coronary artery
Lei Yu1, Tianxiang Gu, Enyi Shi
1Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Insights
On-pump beating-heart revascularization is a viable option for treating chronic total occlusion of the left main coronary artery (LMCA). This surgical approach demonstrated positive outcomes with no perioperative myocardial infarction and improved left ventricular function in patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery
Background:
- Chronic total occlusion of the left main coronary artery (LMCA) is a rare and complex condition.
- Limited surgical data exists for LMCA occlusion, despite potential for well-developed collateral circulation.
- Circulatory instability during cardiac manipulation poses a challenge in LMCA occlusion cases.
Purpose of the Study:
- To evaluate the efficacy and safety of the on-pump beating-heart (OnP-BH) technique for revascularization in patients with LMCA chronic total occlusion.
- To report surgical experiences and outcomes in a series of patients undergoing OnP-BH for LMCA occlusion.
Main Methods:
- Retrospective case review of 8 patients treated between 1999 and 2009.
- Application of on-pump coronary artery bypass grafting with a beating heart (OnP-BH) technique.
- Observation of extracorporeal circulation time, intubation duration, ICU stay, discharge period, and follow-up outcomes.
Main Results:
- Mean extracorporeal circulation: 80.4 minutes; mean intubation: 13.0 hours; mean ICU stay: 3.2 days.
- No perioperative myocardial infarction observed.
- Mean follow-up of 50.9 months showed asymptomatic patients, no deaths, and improved left ventricular function on echocardiography.
Conclusions:
- On-pump beating-heart myocardial revascularization is a feasible alternative for chronic total occlusion of the left main coronary artery.
- The OnP-BH technique offers a safe and effective solution for this challenging condition.
Background And Objectives:
Chronic total occlusion of the left main coronary artery (LMCA) is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart (OnP-BH) technique.
Design And Setting:
Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period (1999 to 2009).
Patients And Methods:
The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed.
Results:
The mean extracorporeal circulation period was 80.4 (19.7) minutes. The mean intubation duration was 13.0 (4.6) hours. The mean intensive care unit stay period was 3.2 (0.7) days, and the mean discharge period was 16.8 (3.3) days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 (34.8) months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function.
Conclusions:
The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA.
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