Early Term Results of Left Internal Mammary Artery Patch to Left Anterior Descending Artery and Left Internal Mammary Artery to On-Lay Saphenous Vein Patch in Diffusely Diseased Left Anterior Descending Artery: Which is Inferior and which is Superior?

Abstract

Early Term Results of Left Internal Mammary Artery Patch to Left Anterior Descending Artery and Left Internal Mammary Artery to On-Lay Saphenous Vein Patch in Diffusely Diseased Left Anterior Descending Artery: Which is Inferior and which is Superior? Background: Surgical revascularization of CAD patients having diffusely-diseased LAD is a difficult surgical problem. Some centers prefer long direct LIMA-to-LAD grafting; others perform LIMA grafts to on lay SVG patch. Favoring either technique depends on multiple factors and is still questionable. This study was undertaken to compare the experience and early results of using direct LIMA-to- LAD anastomosing versus indirect anastomosing by LIMA-to on-lay SVGs during standard CABG. Patients and Methods: This prospective study was done starting from March 2009-untill-March 2011, in Cairo university hospitals and Prince Sultan Cardiac Center, Riyadh, KSA, after obtaining the approval of the local ethical committees. We studied thirty patients with diffusely-diseased LAD. All were submitted for elective CABG using CPB under moderate hypothermia and 20-minutes intermittent blood-enriched aortic root antegrade cardioplegia. Patients were divided into two groups after proper matching regarding demographic data and surgical risks. In Group I (15 patients) underwent LIMA-to-LAD patch; while in group II (15 patients) underwent LIMA grafting on an on-lay SVG. Followup was done at first and twelfth month postoperatively, by regular clinical examination with echocardiography and other investigations as needed. Results: Two patients died in each group (total mortality 13%). In group I, one died due to progressive refractory LV failure; and another one due to refractory ventricular arrhythmias. In group II, a diabetic patient died due to mediastinitis and a second patient died due to progressive liver failure. There were no MI, CHF, or CNS complications. Total morbidity was 20% (6 patients). Group I morbidity was 20% (3 patients) as recurrent attacks of supraventricular extrasystoles arrhythmias in 2 patients (13%); and mechanically-assisted ventilation for 36 hours in single patient (6%). Group II morbidity occurred in 3 patients (20%) as: left side moderate to-severe haemorrhagic pleural effusion in 2 patients (13%), and superficial wound infection in a single patient (6%). All patients expressed obvious post-operative improvement by clinical symptoms (absence of angina pains, 6 MWD) and echocardiographic follow-up (LVEF %). No statistical significance was found between results of the 2 groups regarding operative data (surgical time, CPB time, cross-clamp time), need for inotropics or IABCP, ICU events and hospital stay time. Conclusion: LIMA-to-LAD could be safely-performed using long direct LIMA patch-LAD grafting; and via SVG on-lay patching on LAD too. Both procedures were technically-successful with sound safety, acceptable complications and early term results with no obvious superiority of LIMA patch to Venous patch on LAD.