Left Ostial Stenosis Surgical Angioplasty

Kg, Perreas; Dimitriou, Stergios; Ntalarizou, Evangelia; Kalogris, Panagiotis; Amanatidis, Gregory; Khoury, Michael D.; Karatassakis, George; Michalis, Alkiviadis

doi:10.1055/s-2007-965377

Cited by 3 publications

(5 citation statements)

References 17 publications

(21 reference statements)

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“…This procedure nevertheless has potential limitations, such as complete graft‐dependent perfusion due to the progressive occlusion of the coronary ostium, and the development of arteriosclerosis in venous grafts 14,15 . Direct surgical ostioplasty of the LMCA offers a good alternative by restoring native antegrade flow 10 . In addition, this technique does not preclude percutaneous coronary intervention for the distal coronary tree if necessary at a later stage.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Direct surgical ostioplasty of the LMCA offers a good alternative by restoring native antegrade flow. 10 In addition, this technique does not preclude percutaneous coronary intervention for the distal coronary tree if necessary at a later stage. Two approaches have been described in accessing the LMCA: the posterior 12,16 and the anterior 17 approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty years later, following the improvements in myocardial protection, Hitchcock et al 3 reported promising initial results. The internal mammary artery (IMA), saphenous vein, fresh or glutaraldehyde‐treated pericardium, and pulmonary autografts have all been previously used as onlay patches for ostioplasty of the LMCA 4–12 …”

mentioning

confidence: 99%

“…The internal mammary artery (IMA), saphenous vein, fresh or glutaraldehyde-treated pericardium, and pulmonary autografts have all been previously used as onlay patches for ostioplasty of the LMCA. [4][5][6][7][8][9][10][11][12] In our study, we investigated the possibility of using autologous aortic tissue as a patch, a procedure that has not been previously reported. We also described the short-term and follow-up outcomes of these patients.…”

mentioning

confidence: 99%

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Repair of Left Main Coronary Ostial Stenosis Using Autologous Aortic Tissue

Bilal¹,

Gürer²,

Tanrikulu

et al. 2011

Journal of Cardiac Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Repair of Left Main Coronary Ostial Stenosis Using Autologous Aortic Tissue

Bilal¹,

Gürer²,

Tanrikulu

et al. 2011

Journal of Cardiac Surgery

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“…LMCA stenosis, including ostial lesions, is traditionally managed with coronary artery bypass grafting (CABG). Despite the successful reestablishment of myocardial blood flow, CABG may lead to flow resistance in non-occluded coronaries because of the retrograde perfusion of an extended area of the myocardium [3,4]. Recent advances in interventional cardiology have widened the indications of percutaneous coronary intervention (PCI), and reports from the SYNTAX trial acknowledged that PCI has almost similar results to CABG for non-severe left-main coronary lesions.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of surgical patch osteoplasty in isolated left main coronary stenosis.

Hassan

Aboollo²,

Elghoneimy

2019

Egypt. Cardiothoracic. Surg.

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Background: Coronary artery bypass grafting (CABG) is perceived as the most common treatment for left main coronary artery (LMCA) disease with good results compared to left-main stenting or medical therapy. Surgical patch angioplasty (SPA) may present a substitute to the standard CABG in patients with isolated LMCA disease, and it offers physiological antegrade myocardial perfusion, keeps ostial patency and saves bypass material. The objective of this study is to demonstrate the feasibility of patch osteoplasty in patients with isolated LMCA stenosis. Methods: This is a retrospective study performed on eight patients with angiographically proven ostial or proximal LMCA stenosis who underwent surgical patch angioplasty. Two of them had associated right coronary artery bypass grafting. All patients were performed with cardiopulmonary bypass and saphenous vein patch. An anterior approach with transverse aortotomy was utilized in all cases. Patients were followed-up clinically for a mean period of 14 months (ranging from 26 to 6 months) for recurrence of symptoms and any postoperative complications. Results: The early postoperative period was uneventful in all patients. No perioperative mortality was reported. Two patients had postoperative atrial fibrillation, and one patient with poor left ventricular function required preoperative intra-aortic balloon pump. Angiography was done in the first three cases, and all showed no restenosis and no vein patch dilatation. Conclusion: Surgical patch angioplasty may be a safe and suitable alternative to CABG in selected patients with isolated ostial LMCA stenosis. Further studies are needed to compare the results of the SPA with those of standard CABG and LMCA stenting.

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Surgical patch angioplasty of the left main coronary artery

Harling

Sepehripour

Ashrafian

et al. 2012

European Journal of Cardio-Thoracic Surgery

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Isolated ostial stenosis of the left main coronary artery (LMCA) is rare, occurring in <1% of the patients undergoing coronary angiography. Surgical patch angioplasty (SPA) offers an alternative to conventional coronary artery bypass grafting (CABG) in such cases and is advantageous in restoring more physiological myocardial perfusion, maintaining ostial patency and preserving conduit material. However, a number of early technical failures and high perioperative mortality have limited the generalized uptake of this procedure, and only recently have advances in myocardial protection and novel surgical approaches to the LMCA resulted in a resurgence of the technique. A systematic literature search identified 45 studies incorporating 478 patients undergoing SPA. A variety of patch materials were used, including the pericardium, saphenous vein and internal mammary and pulmonary arteries. Patients were followed up for a mean of 54.4 months. The 30-day mortality was 1.7% and cardiac specific mortality 3.3% at last follow-up. Encouragingly, 92.4% of reported cases (n = 182) showed complete angiographic patency at last follow-up. Our results indicate that SPA may be a viable alternative to CABG in the surgical management of isolated ostial LMCA stenosis. However, no randomized trials have been performed, and it is clear that careful patient selection is essential in minimizing morbidity and mortality in the short- and long-term. Further research is required to allow a direct comparison of SPA to techniques with a more substantial evidence base such as CABG and percutaneous coronary intervention, and to define the optimal patch graft material, elucidating that any beneficial effects arterial patches may have on long-term patency.

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Left Ostial Stenosis Surgical Angioplasty

Abstract: 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.

Cited by 3 publications

References 17 publications

Repair of Left Main Coronary Ostial Stenosis Using Autologous Aortic Tissue

Repair of Left Main Coronary Ostial Stenosis Using Autologous Aortic Tissue

The feasibility of surgical patch osteoplasty in isolated left main coronary stenosis.

Surgical patch angioplasty of the left main coronary artery

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