Reconstruction of long left anterior descending coronary artery successive lesions with left internal mammary artery and saphenous vein graft angioplasty: Early encouraging results

Abstract

BackgroundDiffusely diseased LAD with long stenotic segment or multiple successive lesions in patients indicated for CABG are commonly encountered in our practice nowadays. This is a surgically challenging situation which needs extra-ordinary anastomotic surgical strategies. MethodsBetween May 2011 and April 2014, 37 CABG patients received long anastomotic patch on LAD. In 28 patients a long LIMA layout patch was used (Group I). In 9 patients (Group II), a long piece of reversed SVG was used to reconstruct LAD with LIMA finally anastomosed to SVG used for reconstruction. 30-day post-operative mortality, post-operative myocardial infarction, post-operative need for re-opening, post-operative need for IABC and 1 year post-operative freedom from MACCE were assessed. ResultsLIMA long layout patch was the standard level of care in these cases. We used SVG patch only when LIMA had short length, a very long anastomosis up to distal quarter of the LAD is needed, or small caliber delicate LIMA. In those cases we used SVG to reconstruct LAD then LIMA was anastomosed to the SVG patch. There was 1 re-opening for bleeding (2.7%). There was no post-operative MI. 1 case needed IABC (2.7%) for frequent ventricular extra-systoles that did not respond well to amiodarone, arrhythmia disappeared on 2nd post-operative day. There was no 30-day post-operative mortality. In 1 year follow-up for MAACE only 1 patient (2.7%) showed unstable angina for which coronary catheterization showed occluded SVG anastomosis to a large OM with a de novo lesion distally and PTCA with stenting of the native coronary was done successfully. ConclusionLAD reconstruction with both techniques showed satisfactory results in those surgically challenging cases. In most of cases we utilized long LIMA patch layout as standard level of care using SVG patch with superimposed LIMA anastomoses for technically selected cases.