Indirect Myocardial Revascularization

Abstract

Strategies for indirect myocardial revascularization in end stage ischemic coronary artery disease have been described and are still developing, including transmyocardial laser revascularization, ischemic preconditioning, low-energy shock wave therapy, or epicardial transplantation of latissimus dorsi muscle flap.1–4 All of them are intended to induce angiogenesis and generate neocollaterals to improve regional myocardial perfusion. The latter has been performed in some patients in whom no direct revascularization of the target vessel was possible because of diffuse calcification, small vessel disease, or in patients with multiple stents implanted in a single vessels, leaving no room for bypass anastomosis. We report a successful reperfusion of a formerly occluded left anterior descending coronary artery (LAD) in a patient in whom a free latissimus dorsi muscle flap had been transplanted onto the ischemic anterior epicardial area because of massive LAD calcification and occlusion in December 1995. A 55-year-old male underwent coronary artery bypass grafting for double vessel disease in December 1995 with a venous bypass graft to the right coronary artery. At this time, an additional bypass graft to the occluded LAD was planned. However, the LAD …