10 Plus-Years Follow-Up after Patch Angioplasty of the Left Main Coronary Artery

ABSTRACT

In ostial or proximal left main coronary artery (LMCA) obstruction, re-establishment of normal antegrade flow via the main trunk may be preferable to distal bypass grafting. The objective of this study was to assess the effectiveness of patch plasty of the left main (LM) trunk of the coronary artery for more than 10 years. Direct widening of the LMCA was recommended to patients with ostial, proximal, or midpoint stenosis of the main trunk. Group I of 16 patients had isolated LM obstruction with no distal disease, and Group II of 15 patients had, in addition, right coronary obstruction. The mean age was 60.9 years (age group, 47 to 83 years). Nineteen patients underwent this operation through an anterior transverse aortotomy. No endarterectomies were performed. In Group II, in addition, a single saphenous vein bypass graft was placed in the right coronary artery. There were no operative deaths. Follow-up period extends from 10 to 18 years (mean 11.2). Eight patients had angiography from 3 to 9 years after surgery and all show adequate LM trunk caliber. Noncardiac deaths occured in five patients (26.3%) at 2 months, and 1, 4, 6, and 7 years after surgery. Two women with isolated ostial stenosis diagnosed as a spasm have not shown progression of coronary disease 7 to 9 years after the operation. Widening of the LMCA should be considered in selective cases, only when ostial, proximal, or midportion stenosis of the main vessel exist, even if a right coronary bypass graft is required.

KEYWORDS

Angioplasty - coronary artery - cardiac catheterization - left main coronary artery disease - coronary intervention - saphenous vein - vessel repair

REFERENCES

• 1 Hitchcock J F, Robles de Medina E O, Jambroes G. Angioplasty of the left main coronary artery for isolated left main coronary artery disease.  J Thorac Cardiovasc Surg. 1983;  85 (6) 880-884
• 2 Effler D B, Sones Jr F M, Favaloro R, Groves L K. Coronary endarterotomy with patch-graft reconstruction: clinical experience with 34 cases.  Ann Surg. 1965;  162 (4) 590-601
• 3 Dion R, Verhelst R, Matta A, Rousseau M, Goenen M, Chalant C. Surgical angioplasty of the left main coronary artery.  J Thorac Cardiovasc Surg. 1990;  99 (2) 241-249 discussion 249-250
• 4 Jönsson A, Jensen J, Olsson A, Holm P, Liska J. Follow-up of patients operated on with arterial patch angioplasty of the left main coronary artery.  Ann Thorac Surg. 2006;  81 (4) 1249-1255
• 5 Chikwe J, Kim M, Goldstone A B, Fallahi A, Athanasiou T. Current diagnosis and management of left main coronary disease.  Eur J Cardiothorac Surg. 2010;  38 (4) 420-428
• 6 Raanani E, Kogan A, Shapira Y, Sagie A, Kornowsky R, Vidne B A. Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch.  Ann Thorac Surg. 2004;  78 (5) 1610-1613
• 7 Deuvaert F E, De Paepe J, Van Nooten G, Peperstraete B, Primo G. Transaortic saphenous patch angioplasty for left main coronary artery stenosis. An alternative to coronary artery bypass.  J Cardiovasc Surg (Torino). 1988;  29 (5) 610-613
• 8 Sabiston Jr D C. Manuscript reviewer's comment of Hitchcock et al.  J Thorac Cardiovasc Surg. 1983;  85 884
• 9 Molina J E. Nonreversed saphenous vein grafts for coronary artery bypass grafting.  Ann Thorac Surg. 1989;  48 (5) 624-627