Surgical angioplasty of the left main coronary artery

OBJECTIVE: The conventional surgical treatment of isolated criticalstenosis of the left main coronary artery (LMCA) leads to the definitiveocclusion of LMCA, restores only a retrograde perfusion to a ratherextensive myocardial area and consumes bypass material. Direct surgicalangioplasty avoids thes...

Full description

Saved in:
Bibliographic Details
Published in:European journal of cardio-thoracic surgery 1997-05, Vol.11 (5), p.857-864
Main Authors: DION, R, ELIAS, B, EL KHOURY, G, NOIRHOMME, P, VERHELST, R, HANET, C
Format: Article
Language:English
Subjects:
Angioplasty - methods
Biological and medical sciences
Cardiac Catheterization
Cardiology. Vascular system
Coronary Angiography
Coronary Disease - diagnostic imaging
Coronary Disease - epidemiology
Coronary Disease - surgery
Coronary heart disease
Coronary Vessels - surgery
Female
Follow-Up Studies
Heart
Humans
Male
Medical sciences
Middle Aged
Pericardium - transplantation
Saphenous Vein - transplantation
Time Factors
Treatment Outcome
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:OBJECTIVE: The conventional surgical treatment of isolated criticalstenosis of the left main coronary artery (LMCA) leads to the definitiveocclusion of LMCA, restores only a retrograde perfusion to a ratherextensive myocardial area and consumes bypass material. Direct surgicalangioplasty avoids these inconveniences. METHODS: Between June 1985 andAugust 1996, 49 surgical angioplasties have been performed in 47 patients.LMCA was approached posteriorly in the first 11 procedures, and an anteriorapproach was preferred in the last 38 because of better exposure. The onlaypatch consisted of saphenous vein in 37 cases; pericardium was used in 12cases, and only for ostial stenosis. RESULTS: No technical failure occurredin the last 28 cases. 44 procedures, (90%), succeeded, but 1 patient (2.3%)died later of a massive air embolism, and 2 patients needed conventionalCABG after 3 and 5 months, respectively. The 35 survivors still benefitingfrom a successful LMCA angioplasty on the long term are free of ischemiaafter a mean follow-up of 75 months (2-136). Angiographic restudy wasobtained in 30 patients (70%) at an average of 38 months and revealed anexcellent result in 26 (87%). In 10 patients, a late angiographic restudyat an average of 71 months (32-119) still revealed a perfect result.CONCLUSION: Provided that well-defined contra-indications (involvement ofthe distal bifurcation, heavy calcification) are respected, LMCA surgicalangioplasty deserves a place in the array of surgical strategies.
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(97)01181-0