UNLABELLED: One hundred twenty patients who had diffuse atherosclerotic lesions necessitating reconstruction of the left anterior descending artery with or without open endarterectomy and coronary artery bypass grafting were investigated retrospectively and compared with 130 patients who underwent conventional bypass grafting in the same time frame. METHODS: Sixty-one endarterectomies were performed with long arteriotomies (group I) and 59 patch reconstructions were placed over stenosing plaques without an endarterectomy (group II). Patients having only conventional coronary bypass constituted group III. RESULTS: Hospital mortalities were 6.5%, 5.1%, and 1.5% in group I, group II, and group III, respectively (p = not significant). Five patients in group I (8.1%), six in group II (10.1%), and two in group III (1.5%) had perioperative myocardial infarction (group II vs group III, p = 0.016). Angiographic restudy of grafts to the left anterior descending system revealed a patency rate of 81.5% in group I, 79.1% in group II, and 94.4% in group III patients after mean periods of 6.3, 5.7, and 6.1 years, respectively (p = not significant). Actuarial survivals at 7 years were 94% +/- 5.0%, 74.8% +/- 16%, and 90.9% +/- 7.4% in groups I, II, and III, respectively (group I vs group II, p = 0.007; group II vs group III, p = 0.008). Freedom from recurrent angina at 7 years was 42.7% +/- 15.6% in group I, 33.5% +/- 19% in group II, and 71.9% +/- 14.2% in group III (group I vs group III, p = 0.03; group II vs group III, p = 0.0001). Thirty-four percent of patients in group I, 24% in group II, and 60.4% in group III were working actively in the late postoperative period (p = 0.0001). CONCLUSION: Extended revascularizations of the left anterior descending coronary artery increase surgical risk, although not to a statistically significant degree, and should be performed only of necessity. However, once needed, revascularization is a lifesaving procedure with acceptable early and long-term results.
UNLABELLED: One hundred twenty patients who had diffuse atherosclerotic lesions necessitating reconstruction of the left anterior descending artery with or without open endarterectomy and coronary artery bypass grafting were investigated retrospectively and compared with 130 patients who underwent conventional bypass grafting in the same time frame. METHODS: Sixty-one endarterectomies were performed with long arteriotomies (group I) and 59 patch reconstructions were placed over stenosing plaques without an endarterectomy (group II). Patients having only conventional coronary bypass constituted group III. RESULTS: Hospital mortalities were 6.5%, 5.1%, and 1.5% in group I, group II, and group III, respectively (p = not significant). Five patients in group I (8.1%), six in group II (10.1%), and two in group III (1.5%) had perioperative myocardial infarction (group II vs group III, p = 0.016). Angiographic restudy of grafts to the left anterior descending system revealed a patency rate of 81.5% in group I, 79.1% in group II, and 94.4% in group III patients after mean periods of 6.3, 5.7, and 6.1 years, respectively (p = not significant). Actuarial survivals at 7 years were 94% +/- 5.0%, 74.8% +/- 16%, and 90.9% +/- 7.4% in groups I, II, and III, respectively (group I vs group II, p = 0.007; group II vs group III, p = 0.008). Freedom from recurrent angina at 7 years was 42.7% +/- 15.6% in group I, 33.5% +/- 19% in group II, and 71.9% +/- 14.2% in group III (group I vs group III, p = 0.03; group II vs group III, p = 0.0001). Thirty-four percent of patients in group I, 24% in group II, and 60.4% in group III were working actively in the late postoperative period (p = 0.0001). CONCLUSION: Extended revascularizations of the left anterior descending coronary artery increase surgical risk, although not to a statistically significant degree, and should be performed only of necessity. However, once needed, revascularization is a lifesaving procedure with acceptable early and long-term results.
Authors: Jan D Schmitto; Philipp Kolat; Philipp Ortmann; Aron F Popov; Kasim O Coskun; Martin Friedrich; Samuel Sossalla; Karl Toischer; Suyog A Mokashi; Theodor Tirilomis; Mersa M Baryalei; Friedrich A Schoendube Journal: J Cardiothorac Surg Date: 2009-09-22 Impact factor: 1.637