Left anterior descending endarterectomy and internal thoracic artery bypass for diffuse coronary disease
I S Gill1, D S Beanlands, W D Boyd
1Department of Cardiothoracic Surgery and Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
Insights
Left internal thoracic artery bypass grafting combined with left anterior descending artery endarterectomy offers a beneficial approach for myocardial revascularization in selected patients, demonstrating good long-term patency and survival rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- The efficacy and safety of arterial conduits for bypassing endarterectomized coronary arteries require further definition.
- Retrospective analysis of 74 patients undergoing left internal thoracic artery (LITA) bypass to endarterectomized left anterior descending (LAD) artery from 1989-1994.
Purpose of the Study:
- To evaluate the risk and efficacy of LITA bypass grafting combined with LAD endarterectomy.
- To assess the long-term outcomes, including survival and graft patency, in patients undergoing this combined procedure.
Main Methods:
- Retrospective review of 74 patients (60 male, 14 female; mean age 60.1 years).
- Patients had a mean of 2.95 grafts, with 65% requiring multiple endarterectomies on a mean segment length of 3.1 cm.
- Perioperative data included 25% totally occluded LAD, 45% ejection fraction, and 49 minutes average anoxia time.
Main Results:
- 3 (4.0%) early and 4 (5.4%) late deaths occurred at a mean follow-up of 36 months.
- Actuarial 5-year survival was 84.5%, with 14.7% experiencing recurrent angina.
- Angiographic follow-up in 37.4% showed 74% anastomotic patency and preserved anterior segmental wall motion.
Conclusions:
- LITA bypass with adjunctive LAD endarterectomy is a beneficial strategy for expanding myocardial revascularization scope.
- This combined approach demonstrates acceptable long-term survival and graft patency in carefully selected patients.
Background:
The risk and efficacy of using an arterial conduit to bypass an endarterectomized coronary artery remain incompletely defined. To address this question we analyzed retrospectively 74 patients from 1989 to 1994 in whom bypass grafting using the left internal thoracic artery to an endarterectomized left anterior descending artery was performed.
Methods:
There were 60 men and 14 women with a mean age of 60.1 +/- 8.6 years. Of this cohort, 55 patients (74.3%) had a previous infarction, 18 (24.3%) were diabetic, and 5 (6.7%) had reoperations; 25 patients (34%) had a totally occluded left anterior descending artery and the average ejection fraction was 45%. Each patient had 2.95 +/- 0.52 grafts with 48 patients (65%) requiring multiple endarterectomies. The average length of the endarterectomized segment was 3.1 +/- 1.6 cm. Average anoxia time was 49 +/- 13 minutes. Postoperatively 19 patients (25.6%) required intraaortic balloon and 18 (24.3%) required inotropic support. Perioperative infarction in the left anterior descending artery distribution occurred in 5 patients (6.7%).
Results:
There were 3 (4.0%) early and 4 (5.4%) late deaths at a mean follow-up of 36 +/- 16 months. Recurrent angina was present in 9 patients (14.7%). Actuarial 5-year survival was 84.5%. Angiographic follow-up obtained in 23 patients (37.4%) demonstrated 74% anastomotic patency, with good distal run-off in 13 (65%). The anterior segmental wall motion was preserved.
Conclusions:
The use of the left internal thoracic artery bypass and adjunctive left anterior descending artery endarterectomy to expand the scope of myocardial revascularization in carefully selected circumstances appears to be beneficial.
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