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[Surgical treatment of the left main trunk and left main equivalent coronary artery disease]
1Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, Japan.
Insights
Aorto-coronary bypass grafting for left main trunk (LMT) stenosis showed higher operative mortality and myocardial infarction rates compared to left main equivalent (LME) disease. Complete revascularization improved outcomes and survival in both groups.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Bypass Grafting
Context:
- Left main trunk (LMT) stenosis and left main equivalent (LME) disease are critical conditions requiring surgical intervention.
- Aorto-coronary bypass grafting (ACBG) is a standard treatment for these conditions.
- Comparative analysis of operative and hemodynamic results is essential for optimizing patient care.
Purpose:
- To compare the operative and hemodynamic outcomes of ACBG in patients with LMT stenosis versus LME disease.
- To evaluate the impact of complete revascularization on postoperative left ventricular function and survival.
- To identify factors influencing outcomes in patients undergoing ACBG for complex coronary artery disease.
Summary:
- A study compared ACBG in 9 LMT stenosis and 20 LME patients. Group I (LMT) had higher operative mortality (11.1%) and perioperative myocardial infarction rates than Group II (LME) (5.0%).
- Both groups showed significant improvements in cardiac index and left ventricular ejection fraction postoperatively.
- Complete revascularization correlated with better left ventricular function, angina resolution, improved NYHA classification, and high 8-year survival rates (88.2% for LMT, 84.6% for LME).
Impact:
- The findings highlight the need for stringent perioperative management and complete revascularization in LMT stenosis patients.
- This study provides valuable insights into the long-term efficacy and safety of ACBG for complex coronary artery disease.
- Optimized surgical strategies can lead to improved patient outcomes and survival in high-risk cardiac patients.
Abstract:
The comparative studies on operative and hemodynamic results following aorto-coronary bypass grafting were performed in 9 patients with left main trunk (LMT) stenosis and 20 with left main equivalent (LME). One of 20 LME had bypass grafts occluded on the postoperative angiogram. There were two operative deaths, one in LMT, another in LME, and one late death. Following results were obtained in 8 LMT (Group I) and 15 LME (Group II) whose all bypass grafts were patent. There were significantly higher operative mortality rate and the incidence of perioperative myocardial infarction in Group I (11.1% versus 5.0%). Cardiac index and left ventricular ejection fraction significantly increased postoperatively in both groups. Mean Vcf and PLVSP/LVESV significantly increased postoperatively in Group II, but not in Group I. Left ventricular anterior segmental wall motion significantly increased in both groups and apical in Group I, whereas it did not in the postero-inferior segment. The completely revascularized patients had a better postoperative left ventricular function comparing with the incompletely revascularized patients. Angina disappeared postoperatively in all patients in Group I and 12 (75%) in Group II. In both groups, NYHA classification was improved from class III or IV preoperatively to class I or II postoperatively. Postoperative 8 years actuarial survival rate was 88.2% in Group I and 84.6% in Group II. In conclusion, it was suggested that much more strict perioperative management and complete revascularization were needed in the patient with LMT.