Surgical patch ostiumplasty of the left main coronary artery

The prevalence of ostium stenosis of the left main coronary artery, isolated or not, varies from 0.1% to 1.9%. Could ostium angioplasty and reconstruction of the proximal left main coronary artery be a real surgical alternative for this condition? What are the risks and which are the results? In the present study we have reviewed our experience of 10 patients undergoing ostium angioplasty (mean age 55 years; male/female 6/4). Four of the operations were reoperations. There was only one hospital mortality and the incidence of postoperative morbidity was low. Only one patient (a reoperation) required blood transfusion to compensate for a minor diffuse postoperative bleeding. All hospital survivors were followed up for an average period of 7 months (range 3-56). Eight of the 9 surviving patients were in perfect clinical condition at the end of the follow-up, only one was in NYHA class II and CCS class 2. The mean LVEF at the end of the follow-up was normal and the mean ergometry capacity was 159 +/- 18W. Follow-up coronary angiography showed no tendency to restenosis in any of the cases. Ostium patch angioplasty offers several advantages over conventional coronary artery bypass grafting. Reoperation, preoperative unstable angina, or poor left-ventricular function pose no contraindications for ostium angioplasty. Presence of aortic and/or ostium calcifications, however, constitutes an absolute contraindication. Ostium patch angioplasty of the proximal left main coronary artery should be considered a surgical alternative in selected patients.