Left Ostial Stenosis Surgical Angioplasty

Abstract

Background: Left main coronary stenosis, including ostial lesions, is conventionally treated by coronary bypass surgery. This approach, however, restores a less physiological retrograde perfusion to part of the myocardium and may contribute to a competition of flows in non-occluded coronaries. Direct surgical reconstruction of the LMCA has been described and theoretically avoids these potential drawbacks.

Methods: From May 1995 until December 2005, 25 patients with ostial left main stenosis underwent surgical angioplasty in our unit. Patients were all followed up clinically and with transesophageal echocardiography. Results: Mean age of the patients was 59.7 years (range, 33 - 73 years). The male to female ratio was 14 : 11. The left main coronary stem was approached anteriorly in all patients. The onlay patch consisted of saphenous vein and was extended across the aortotomy suture line. There were no early deaths or perioperative myocardial infarctions. All patients underwent follow-up clinical examination and transesophageal (TOE) echocardiography as well as other investigations when required. TOE demonstrated a wide open left main coronary artery normal flow pattern, and no aneurysmal dilatation or calcification of the onlay patch in 24 patients. After a mean follow-up of 8 years, the all-cause survival was 88 %, while event-free survival was 80 % with 21 pts remaining in CCS I. Conclusion: Surgical reconstruction of the LMCA is a safe and effective treatment for left main stenosis. Re-institution of normal blood flow through the left main coronary artery possibly confers advantages over bypass surgery.

Key words

coronary bypass surgery - cardiovascular surgery - myocardial protection

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