[Surgical plasty of the left main coronary artery]

Critical stenosis of left main coronary artery (LMCA) is usually treated by conventional bypass surgery. However, this approach consumes an appreciable length of conduit, leads to occlusion of LMCA, and restores only a retrograde perfusion of a rather extensive myocardial area. As from June 1985, we performed 13 LMCA patch plasties in 12 patients. LMCA was approached either posteriorly via a curved aortotomy (9 cases), or anteriorly (4 cases) after retraction, partial or complete division of the main pulmonary artery. In 1 patient, a posterior LMCA plasty failed and a conventional double by-pass graft was needed. This patient underwent, 8 months later, a successful repeat patch plasty using a transpulmonary anterior approach. There was no perioperative myocardial infarction. There was no mortality. All of the patients underwent a 6 months postoperative angiographic control, with an excellent result in 12 cases: a significant restenosis of LMCA was successfully treated by percutaneous coronary angioplasty in 1 asymptomatic patient having concomitantly received a sequential mammary graft. All of the 4 patients are asymptomatic. A direct surgical approach to critical stenosis of LMCA is a valuable alternative treatment for this condition.