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Emergency surgical treatment for total left main coronary artery occlusion. A report of 2 cases
A Lijoi1, F Della Rovere, G C Passerone
1Cardiac Surgical Department, Università di Genova, Italy.
Insights
Successful surgical revascularization for acute total left main coronary artery occlusion is rare but achievable. Aggressive surgical intervention and collateral circulation significantly improve patient survival and functional outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Total left main coronary artery occlusion carries a high mortality rate, with limited successful treatment options reported.
- Existing treatments for acute occlusions include intracoronary streptokinase and percutaneous transluminal coronary angioplasty, with no prior reports of successful surgical intervention.
- The rarity of reported cases (84 worldwide) underscores the critical nature of this condition.
Observation:
- Two cases of surgically treated patients with acute or evolving total left main coronary artery occlusion are presented.
- Both patients had significant (≥80%) stenosis of the right coronary artery.
- Surgical reperfusion was achieved within 2 hours of total occlusion in both cases.
Findings:
- Both patients survived the acute event and remained in New York Heart Association functional class I or II postoperatively.
- The study highlights the potential for successful surgical revascularization in acute total left main coronary artery occlusion.
- Right coronary artery-to-left anterior descending collaterals may offer a protective effect.
Implications:
- This study suggests that aggressive surgical revascularization can be a viable and life-saving option for acute total left main coronary artery occlusion.
- The findings emphasize the importance of rapid reperfusion in managing this critical condition.
- Understanding the role of collateral circulation may guide future treatment strategies for left main coronary artery disease.
Abstract:
Treatment of total left main coronary artery occlusion is rarely reported (84 chronic and acute cases in the world literature), due to the high mortality rate from massive myocardial infarction. Acute occlusions have been treated with intracoronary streptokinase, with percutaneous transluminal coronary angioplasty, or with both. To date, there has been no report of successful surgical revascularization in an acute case. We present 2 cases of surgically treated patients who survived total left main coronary artery occlusion that appears to have been acute, or acutely evolving. Both patients had an 80% or greater stenosis of the right coronary artery, yet have remained in New York Heart Association functional class I or II postoperatively. We attribute this not only to the aggressive surgical approach, which enabled reperfusion to be achieved within 2 hours of total occlusion, but to the protective effect in these patients of right coronary-to-left anterior descending collaterals.