Coronary flow reserve in patients with left anterior descending artery-left internal mammary artery long patch plasty anastomosis: a prospective study

Abstract

BackgroundWe aimed at assessing the efficacy of the patch plasty technique without endarterectomy in patients with diffuse coronary artery. Long anastomosis of the left internal mammary artery graft (LIMA) to the left anterior descending (LAD) artery was performed and examined using transthoracic Doppler echocardiography to detect coronary flow reserve (CFR) and epicardial stenosis.MethodsForty-one patients (6 women; mean age, 58 ± 9 years) who underwent coronary artery bypass surgery using the patch plasty technique without endarterectomy were included in the study. Presence of CFR was examined in each patient by transthoracic Doppler echocardiography.ResultsOne of the patients (2.4%) died on the first postoperative day. The remaining patients were divided into 2 groups: those with normal CFR (CFR ≥ 2) (n = 35, 88%) and those with low CFR (CFR < 2) (n = 5, 12.0%). The length of patch plasty (3.6 ± 0.82 cm) in the low CFR group was significantly longer than that in the normal CFR group (2.69 ± 0.75 cm). Coronary angiography was performed for the 3 patients with CFR < 2: Two patients showed normal grafts and anastomoses, but the third patient’s distal LAD-LIMA anastomosis was almost 90% occluded.ConclusionWe elucidated the reliability of the patch plasty without endarterectomy method and transthoracic Doppler echocardiography for detecting the severity of coronary artery disease.

Long-segment patchplasty of diffuse left anterior descending artery disease on the beating heart

“…Similarly, patients who underwent LITA patchplasty without endarterectomy were reported to have similar results to patients treated with conventional CABG. 2 In our patients with LITA onlay patchplasty without endarterectomy on the beating heart, peri-operative MI was found to be 3.7% and the mortality rate was 5%. Our results are acceptable for patients with diffuse LAD lesions.…”

“…When a simple bypass cannot be performed due to diffuse LAD artery disease, there is no need for endarterectomy during the LITA onlay patchplasty. 2 The risk of thrombosis is minimised since the endothelial layer is not damaged in LITA onlay patchplasty without performing endarterectomy. We routinely treat our patients with dual antiplatelet therapy with clopidogrel and acetylsalicylic acid and we have not encountered any complications originating from the anastomotic line.…”

“…1 In surgical tratment of diffuse/multisegment LAD disease, endarterectomy, long-segment patchplasty without endarterectomy, sequential jumping bypass and bypass grafting with two different grafts can be performed. 2 In diffuse LAD lesions, plaque exclusion with the left internal thoracic artery (LITA) is a safe method and has similar results to conventional coronary artery bypass graft (CABG) surgery with no diffuse lesions. 1 In this article, we present our LITA onlay patchplasty experience on the beating heart in multisegment LAD lesions.…”

A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery?

“…We also found that statin use had a positive impact on the LIMA flow. As the preferred conduit option, LIMA has been used for LAD grafting for many years, and it is well known that LIMA grafts are more durable and have higher patency rates than other conduit options in patients with diffuse coronary artery disease [Haberal 2015]. In our study, LAD to LIMA grafting was not performed in 28 (4.09%) patients who underwent the CABG procedure due to low LIMA flow.…”