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Eur J Cardiothorac Surg 2000;17:509-514
© 2000 Elsevier Science NL

Surgical angioplasty with exclusion of atheromatous plaques in case of diffuse disease of the left anterior descending artery: 2 years’ follow-up

Service de Chirurgie Cardiaque, Thoracique et Vasculaire, CHU Hôpital de la Cavale Blanche, 29609 Brest, France

Corresponding author. Tel.: +33-2-9834-7428; fax: +33-2-9834-7417

Objective: A new surgical technique of coronary artery angioplasty for diffuse and extensive lesions of the left anterior descending artery (LAD) is evaluated in this study. Method: Ninety-four coronary artery reconstructions (CAR) using a new technique of angioplasty of the LAD were performed: mean age of patients was 59±8 years, there were 21 patients with unstable angina, and 21 with recent myocardial infarction (MI). Surgical technique: Diseased LAD is bypassed with the internal thoracic artery graft (ITA). The anastomosis is made downstream from the significant proximal lesion of the LAD. A long arteriotomy (from 2 to 12 cm) is performed along the LAD up to the healthy arterial wall, followed by coverage with the onlay graft of ITA in such a fashion as to exclude the plaques from the LAD lumen. The wall of the new reconstructed LAD consisted of 75% of ITA and 25% of native LAD. The remaining part of the native LAD forms a posterior gutter giving the origins of septal and diagonal branches. Results: aortic cross-clamping time was 116 min, operative mortality rate was 3.2% (three patients), peri-operative infarction rate 6.6% (six patients). The follow-up was 29 months (SD=10). Of the 91 survivors, two were lost for follow-up and one died of non-cardiac causes. Of the 88 patients clinically evaluated, 81 were free from angina and other cardiac events, two had new myocardial infarction in a non-grafted area, two were in congestive heart failure, and three in angina class II. Sixty patients underwent angiography. There were 57 perfect-patency CAR (95%), two ITA string sign (competitive flow), two ITA occlusions (2.5%) and no re-stenosis. Conclusions: CAR allows revascularisation of diffusely diseased LAD with acceptable operative mortality and morbidity, 2 years’ good clinical results and graft patency. In this series, exclusion of plaques prevented plaque complications.

Key Words: Coronary artery surgery • Coronary artery angioplasty • Coronary artery endarterectomy • Atheromatous plaque complications • Coronary artery reconstruction • Internal thoracic artery

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