EXTENSIVE ENDARTERECTOMY, ONLAY PATCH, AND INTERNAL MAMMARY BYPASS OFTHE LEFT ANTERIOR DESCENDING CORONARY-ARTERY

The incidence of diffuse disease requiring multiple endarterectomies i s high among the Oriental population. The technique of LAD endarterect omy and reconstruction is difficult, and often it is a challenging pro blem. From June 1987 to September 1994, 2376 patients from seven count ries underwent coronary artery bypass graft surgery, among whom 610 pa tients had endarterectomy. One hundred thirty-six patients underwent L AD endarterectomy, and among them, 69 had extensive endarterectomy. Th e LAD was reconstructed with IMA onlay patch in 41 patients and with s aphenous vein onlay patch in 28 patients. Three patients had evidence of postoperative myocardial infarction and seven patients died in the postoperative period. Twelve patients were postoperatively restudied a nd in all of them, the graft to LAD was patent. Use of internal mammar y artery onlay patch after endarterectomy is advantageous since it may be associated with higher long-term patency and low incidence of reop eration. To our knowledge, this has not been reported anywhere.