Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing
Arif Gucu1, Tuğrul Goncu1, Senol Yavuz1
1Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training & Research Hospital Bursa, Turkey.
Insights
This study introduces a novel surgical technique for complete myocardial revascularization in patients with multisegmental left anterior descending (LAD) disease. The safe and efficient method ensures perfusion to both proximal and distal LAD segments, showing promising results.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Complete myocardial revascularization is the primary goal in coronary artery disease surgery.
- Multisegmental left anterior descending (LAD) disease often requires complementary revascularization strategies.
- Existing techniques may not always achieve complete revascularization for complex LAD lesions.
Purpose of the Study:
- To present an alternative surgical technique for achieving complete myocardial revascularization.
- To evaluate the safety and efficacy of this novel approach in patients with multisegmental LAD disease.
Main Methods:
- Retrospective analysis of eight patients undergoing the novel procedure between January 2008 and August 2013.
- Standard cardiopulmonary bypass with coronary artery bypass grafting.
- Construction of a 'bridge' using a valveless saphenous vein graft (SVG) across LAD stenoses, with left internal mammary artery (LIMA) anastomosis to the bridge.
Main Results:
- The innovative technique was successfully performed in all eight patients.
- No morbidity or in-hospital mortality was observed.
- One-year follow-up showed no complications, with patent LIMA-to-bridge anastomosis in two patients.
Conclusions:
- This technique offers a safe, easy, and efficient method for complete revascularization in multisegmental LAD disease.
- The procedure demonstrates good results and is easily implementable.
- It effectively perfuses both proximal and distal segments of multisegmental LAD stenoses.
Objectives:
The basic aim of surgical interventions in patients with coronary artery disease is to complete myocardial revascularization. In such patients, however, complementary revascularization techniques may require in patients with multisegmental left anterior descending disease. Among the different procedures, we performed an alternative option in patients with multisegmental lad disease for providing complete myocardial revascularization.
Methods:
This study consists of retrospective analysis of consecutive eight patients between january 2008 and august 2013. In all patients, the surgical procedure consisted of standard aortic and right atrial cannulations followed by coronary artery bypass grafting with cardiopulmonary bypass. At the lesions of non-lad vessels distal anastomoses were performed with saphenous vein graft. After that lad arteriotomies were performed at the proximal and the distal segment of coronary stenosis, and a bridge was formed with a short segment valveless svg. The left internal mammary artery was anastomosed on the bridge.
Results:
This innovative technique was performed successfully in all the patients. There were no morbidity and in-hospital mortality. At follow-up 1 year control, all the patients have no complications. In 2 patients, control angiogram showed a patent lima to a bridge anastomosis.
Conclusions:
Although our series has a small group population, we advocate that this is a safe, easy, and efficient technique for providing complete revascularization in multisegmental lad disease. This technique could be performed with the good result and easy implementation. It perfuses both the proximal and the distal segments of the multisegmental lad stenoses.
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