Mid‐Term Outcome of Surgical Coronary Ostial Plasty: Our Experience

Abstract

The conventional coronary artery bypass procedure that uses venous or arterial conduit for isolated critical stenosis of the left main coronary artery (LMCA) restores a less physiological perfusion of the myocardium and uses a n appreciable length of bypass material, Coronary ostial plasty has been described as an alternative surgical technique in proximal obstructive coronary artery disease without calcifications. Here w e report 23 patients (15 males and 8 females aged 37-78 years; mean age 57 years) who underwent surgical ostial plasty. Ostial reconstruction with fresh pericardial patch was performed in all patients: 15 patients with LMCA stenosis, 6 patients with right coronary (RC) ostial stenosis. and 2 patients with both RC artery and LMCA stenosis. In seven cases, coronary artery bypass grafting was added for contralateral distal stenosis with a total of five arterial conduits and six venous grafts. One patient died; the ostial plasty and grafts were patent at necropsy. Thallium-201 myocardial scintigraphy under stress a t 30 days t o 6 months after operation demonstrated good myocardial perfusion in 21 of 22 patients. Coronary angiography at follow-up (49 k 8 months) demonstrated good surgical ostial plasty results in 21 of 22 patients and good coronary flow in 19 of 22 patients; angiographic study at mid-term follow-up revealed only one failure of the surgical ostial plasty technique associated with venous graft obstruction. In 2 other patients CABG failure due t o venous graft obstruction (lpatient) or distal stenotic lesions of the left coronary artery (1 patient) was noted. The overall successful outcome of the surgical ostial plasty was 22 of 23. We believe that surgical angioplasty of the coronary ostia may be used in t h e presence of proximal noncalcified obstructive lesions as an alternative technique, which offers a more physiological revascularization; it also spares grafting material and allows subsequent percutaneous transluminal angioplasty or coronary artery bypass surgery. IJ Card Surg 7999; 14:294-300) Coronary artery bypass grafting (CABGI is the standard surgical procedure for patients with coronary artery disease (CADI. In patients with critical stenosis of the left main coronary artery (LMCAI, the standard CABG procedure restores a less physiological perfusion of the myocardium, possibly leads to occlusion of the left coronary (LC) ostium, and consumes an appreciable length of bypass material. Surgical angioplasty of the LMC* Or right coronary (RC) artery has been described in selected cases of proximal lesions.

Isolated left main coronary artery stenosis: long term follow up in 106 patients after surgery

“…The overall success rate after a follow up period of 49 months was 22/23. 18 That study confirms our positive results with the technique.…”

Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience

“…As chronic total LMS occlusion is a progressive lesion, and patients have a calcified proximal LMS, we do not consider that they are appropriate candidates for surgical angioplasty or reconstruction of the left coronary ostium and left main stem, although it is a good option for isolated ostial LMS stenosis with a normal distal left system. 17 We agree with Ipek and colleagues 5 that priority should be given to retrograde filling vessels of the left system, followed by grafts to the obtuse marginal and diagonal branches, and finally the RCA if diseased. Sugishita and colleagues 4 studied 3 patients with chronic total LMS occlusion (2 had atherosclerotic disease, 1 had Kawasaki disease) who underwent successful CABG; all had a dominant RCA with good collaterals to the left system, which are necessary for patients to survive chronic total LMS occlusion with preserved LV function; 2 were followed up for more 10 years after surgery.…”

Patch Angioplasty for Isolated Ostial Stenosis of the Left Main Coronary Artery

“…Atherosclerosis is the most common etiology of left coronary artery stenosis 5–7 . This most likely reflects prevalence of cardiovascular risk factors in patients having left coronary artery stenosis.…”

“…Conventional CABG is recognized as the treatment of choice for this condition with excellent results 14 . Conventional CABG may lead to the occlusion of the coronary ostium and restores a less physiological retrograde myocardial perfusion, which can result in competitive flows 7 . Surgical angioplasty avoids these drawbacks and, in addition, the coronary artery ostium remains open and can be used as an access for percutaneous transluminal coronary angioplasty in case of stenosis developing in a later stage in the distal LCA 6,7,15 .…”

“…5 Atherosclerosis is the most common etiology of left coronary artery stenosis. [5][6][7] This most likely reflects prevalence of cardiovascular risk factors in patients having left coronary artery stenosis. Other causes for developing an isolated left coronary artery stenosis are inflammatory diseases such as Takayasu or syphilitic aortitis, 8,9 postradiation therapy, 10 idiopathic 11 or fibromuscular dysplasia, 12 as well as iatrogenic causes.…”