Use of operative transluminal coronary angioplasty as an adjunct to coronary artery bypass.

Operative transluminal coronary angioplasty (OCTA) was used to improve coronary artery bypass graft (CABG) runoff in patients having complex segmental and diffuse coronary artery obstructions. OTCA was performed during CABG through the bypass arteriotomy on 64 arteries in 58 patients. An angioplasty system specifically designed for operative use was employed. In 13 cases, angioplasty was performed both proximal and distal to the coronary arteriotomy, for a total of 77 angioplasty sites. Elective restudy was performed on 36 angioplasty sites in 28 arteries in 24 patients: Sixteen patients were restudied between 18 and 21 days (mean 16) and eight between 4 and 32 months (mean 20.5). Patency rate, as assessed at each angioplasty site, was 86.1% (20/24 studied early and 11/12 studied late). Three coronary perforations (4.7%) occurred and were repaired without perioperative infarction or other sequelae. The one operative death (1.7%) occurred in a patient with preoperative refractory cardiogenic shock. There were seven perioperative infarctions (12.1%), of which three (4.7%) were in the distribution of the coronary artery undergoing OTCA. The favorable short-term and medium-term patency rates indicate that OTCA is a useful adjunct to CABG that permits more complete revascularization of small or diffusely diseased coronary arteries.