Surgical angioplasty of the left main coronary artery

The conventional surgical treatment of isolated critical stenosis of the left main coronary artery restores a less physiologic perfusion of the myocardium, leads to occlusion of the left coronary ostium, and consumes an appreciable length of bypass material. Starting in June 1985, 23 surgical angioplasties have been performed in 22 patients. The left main stem was approached posteriorly in the first 11 patients, and an anterior approach was preferred in the last 12 because of better exposure. The onlay patch consisted of saphenous vein in the first 14 patients; pericardium was preferred in the last nine. The five failures occurred early. Four of these occurred in patients older than 60 years in whom calcifications of the left main stem had been seen on the preoperative angiogram. Eighteen procedures (78.3%) succeeded, but one patient (5.5%) died later of a massive air embolism. The 17 survivors are free of symptoms (maximal stress test combined with thallium scintigraphy) after a mean follow-up of 24.3 months. Angiographic restudy at an average of 8 months was obtained in 14 patients (82.3%) and revealed an excellent result in 13. In five patients, a late angiographic restudy (22 to 37 months) still revealed perfect patency of the left main stem. Provided that well-defined contraindications (calcifications, involvement of the distal bifurcation, older age) are respected, surgical angioplasty deserves a place in the array of surgical strategies.