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

Abstract

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.

Selecting the optimal treatment for left main coronary disease: The importance of identifying subgroups of patients

“…The application of these concepts on a relative basis to nondominant coronary systems might explain the angiographic results of the RCTs. The option for direct patch enlargement of the LM coronary artery exists only for patients with an ostial stenosis where there is absence or minimal atheromatous disease in the LM trunk (Figure 3) and although this can provide good results, 19 only small series of this procedure have been reported and no comparative studies have consistent with current common practice and guidelines, 20,21 and represents the only situation in which PCI is recommended in stable angina with an expectation of prognostic benefit, despite the absence of direct evidence supporting that expectation.…”

“…The application of these concepts on a relative basis to nondominant coronary systems might explain the angiographic results of the RCTs. The option for direct patch enlargement of the LM coronary artery exists only for patients with an ostial stenosis where there is absence or minimal atheromatous disease in the LM trunk (Figure 3) and although this can provide good results, 19 only small series of this procedure have been reported and no comparative studies have been undertaken. Accordingly, patients with isolated noncomplex LM stenosis (including selected patients with stenoses extending into the proximal left anterior descending artery only) should be offered PCI based on noninferiority with respect to survival.…”

Correlation of Post-Operative Outcomes in patients undergoing CABG Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus Retrograde Cardioplegia: A Prospective Review

“…Cardioplegia solution is administered retrogradely by entering the right atrium through the coronary sinus orifice. In high-risk individuals, ante-grade and retrograde cardioplegia is known to produce improved cardiac enzyme and LV function findings [5][6][7][8] .…”