Surgical angioplasty of the left main coronary artery

• 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
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)01181-0

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.