Revascularization of the stenotic left main coronary artery and impaired left ventricle.

The high mortality rate associated with revascularization for stenosis of the left main coronary artery and impairment of the left ventricle (classes III and IV) has been significantly reduced by a twofold approach: combating hypotension during induction of anesthesia and preventing ischemia resulting from anoxic arrest, often needed to facilitate the insertion of the left coronary anastomoses. These two goals have been successfully achieved by (1) a readiness to institute circulatory assist by means of femoral-to-femoral cardiopulmonary bypass and (2) augmentation of coronary flow through immediate insertion of a vein graft between the aorta and right coronary artery, if the anatomy permits.