Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

Abstract

PurposeSeveral alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study.Patients and MethodsIn order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months.ResultsSeventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%).ConclusionWe strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.

Surgical management of diffusely diseased coronary arteries

“…Multiple sequential anastomoses to LAD have been described as an alternative procedure for treating multilevel LAD lesions [20][21][22]. LITA was anastomosed side to side for the proximal part of LAD and anastomosed end to side for the distal part of LAD.…”

Edge‐to‐Edge Technique to Minimize Ovelapping of Multiple Bioresorbable Scaffolds Plus Drug Eluting Stents in Revascularization of Long Diffuse Left Anterior Descending Coronary Artery Disease

“…Surgical treatment of long, diffuse LAD disease is still a matter of investigation. Sequential left internal mammary artery (LIMA) implantation, although feasible with good outcomes, is limited by the number of segments to be treated (usually no more than 2), whereas the use of LIMA plus long segment endarterectomy has been proposed to be beneficial but is complicated by an operative mortality of 3.0 to 4.0% and a perioperative myocardial infarction rate of 4.0% . The full‐metal jacket technique using DES, despite being considered relatively safe and effective, showed on long‐term, rates of cardiac death, MI, TLR, and TVR of 6%, 6%, 27%, and 30%, respectively.…”

Cardiac surgery Long onlay bypass grafting using the left internal mammary artery for proximal and mid stenosis of the left anterior descending artery

“…Some authors suggest the use of sequential grafting in multisegment stenotic LAD arteries [9]. However, sequential grafting has its disadvantages: proximal anastomosis may cause kinking of LIMA grafts and proximal anastomotic stenosis may occur on LIMAs when wide suture bites are taken.…”