Patch Angioplasty in Diffusely Diseased Left Anterior Descending Coronary Artery

Abstract

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

Vein Patch Angioplasty with Internal Mammary Artery Grafting of the Left Anterior Descending Coronary Artery

“… 9 Vein patch angioplasty has a mortality rate of 1.2 to 4.8% while the perioperative myocardial infarction ranged from 0-8%. 6 - 8 The overall reported mortality for long segment LAD reconstruction with endarterectomy ranged from 2.5 to 10%. 9 Bitan compared vein patch angioplasty and endarterectomy patients and found similar short-term survival and freedom from myocardial infarction.…”

“…Vein patch angioplasty with LIMA anastomosis to the patch has been reported by several authors with good early and medium-term results. [6][7][8] Alternatively, the successful use of the LIMA alone as an onlay patch for the extended arteriotomy with acceptable early and midterm results has also been described. [9][10][11] Others have performed the LAD reconstruction with the LIMA using an off-pump procedure with very good early and midterm results.…”

“…Most of the reports from foreign literature cite it as a safe and feasible option with acceptable clinical outcomes in this subgroup of patients. 7 , 8 There is no locally published data.…”

“…5 An alternative technique, patch angioplasty, utilizes an arteriotomy (with or without a short endarterectomy) across the more distally located atherosclerotic plaque and patch reconstruction with saphenous vein prior to the anastomosis of the left internal mammary artery (LIMA). [6][7][8] It is easier to perform, causes less arterial trauma with consequently less possibility of thrombosis than endarterectomy, and avoids the potential for competitive flow seen in multiple grafts on the same artery.…”