Vein Patch Angioplasty with Internal Mammary Artery Grafting of the Left Anterior Descending Coronary Artery

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Surgery

Background:

• Diffuse coronary artery disease, particularly in the left anterior descending (LAD) artery, presents a significant challenge in surgical revascularization.
• Traditional bypass grafting may be insufficient for diffusely diseased vessels, necessitating alternative techniques.

Purpose of the Study:

• To evaluate the treatment outcomes of coronary artery bypass grafting (CABG) using vein patch angioplasty combined with internal mammary artery (IMA) grafting for the LAD artery.
• To assess the safety and efficacy of this combined approach in patients with diffuse LAD stenosis.

Main Methods:

• A retrospective observational study involving 26 patients who underwent LAD vein patch angioplasty with IMA grafting.
• Data collected included demographic profiles, intraoperative details, and postoperative outcomes (mortality, morbidity, myocardial infarction, NYHA functional class).
• Statistical analysis included Student's t-test for comparing preoperative and postoperative NYHA functional class.

Main Results:

• The study included 22 males and 4 females (mean age 62 years), with 96% having three-vessel disease.
• In-hospital mortality was 7.7% (2 patients), and morbidity was 11.5% (3 patients).
• A significant improvement in mean NYHA functional class was observed, from 2.85 preoperatively to 1.5 postoperatively (p<0.00001), with no perioperative myocardial infarction.

Conclusions:

• Vein patch angioplasty combined with IMA grafting is a valuable technique for managing diffuse coronary stenosis of the LAD artery.
• This approach demonstrates acceptable early clinical results and significant functional improvement in patients.