Background: Severely diseased left anterior descending coronary artery (LAD) is a surgical challenge and several procedures were suggested to achieve adequate reconstruction. Aim of the work:The aim of this study is to assess safety and surgical outcome of the use of patch angioplasty for the reconstruction of severely diseased LAD. Material and methods:In the period between January 2009 and January 2012, 40 patients were chosen for reconstruction of a diffusely diseased left anterior descending coronary artery (LAD) with either left internal mammary artery (LIMA) patch or saphenous vien patch. Other associated significant coronary artery lesions were classically grafted with Inverted saphenous vein.Results: LAD patch was feasible in all cases and varied in length from 2-8 cm (5.1 + 1.8). Mean number of arterial and venous grafts was 2.1 + 0.64, mean aortic crossclamp time and bypass times were 60.8 + 18.2 and 80.2 + 23 minutes, mean ICU and hospital stays were 44.9 + 10.3 hours and 9 + 3.2 days; respectively. There were one hospital mortality and one complications by deep sternal wound infection , patients were followed up from 1 month to 3 months. Mean postoperative NYHA class (1.2 + 0.4) significantly improved, compared to the preoperative values (3.6 + 0.52; P<0.001). Conclusion:The use of LAD patch angioplasty is generally feasible and a safe alternative for the reconstruction of severely diseased LAD. KeywordsCoronary artery bypass grafting; Left anterior descending coronary artery; Left internal mammary artery; LAD venous and or arterial angioplasty