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J Thorac Cardiovasc Surg 1996;112:745-754
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

LONG-TERM RESULTS OF RECONSTRUCTIONS OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY IN DIFFUSE ATHEROSCLEROTIC LESIONS

Received for publication Feb. 13, 1996 Revisions requested March 7, 1996; revisions received March 28, 1996 Accepted for publication April 1, 1996. Address for reprints: Ugursay Kifiltepe, MD, Department of Cardiovascular Surgery, Türkiye Yüksek htisas Hospital, Sihhiye, Ankara 06100, Turkey.

Abstract

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. (J THORACCARDIOVASCSURG1996;112:745-54)

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