SURGICAL PATCH OSTIUMPLASTY OF THE LEFT MAIN CORONARY-ARTERY

The prevalence of ostium stenosis of the left main coronary artery, is olated or not, varies from 0.1% to 1.9%, Could ostium angioplasty and reconstruction of the proximal left main coronary artery be a real sur gical alternative for this condition? What are the risks and which are the results? In the present study we have reviewed our experience of 10 patients undergoing ostium angioplasty (mean age 55 years; male/fem ale 6/4). Four of the operations were reoperations. There was only one hospital mortality and the incidence of postoperative morbidity was l ow. On ly one patient (a reoperation) required blood transfusion to co mpensate for a minor diffuse postoperative bleeding, All hospital surv ivors were followed up for an average period of 7 months (range 3-56). Eight of the 9 surviving patients were in perfect clinical condition at the end of the follow-up, only one was in NYHA class II and CCS cla ss 2, The mean LVEF at the end of the follow-up was normal and the mea n ergometry capacity was 159+/-18W. Follow-up coronary angiography sho wed no tendency to restenosis in any of the cases. Ostium patch angiop lasty offers several advantages over conventional coronary artery bypa ss grafting. Reoperation, preoperative unstable angina, or poor left-v entricular function pose no contraindications for ostium angioplasty, Presence of aortic and/or ostium calcifications, however, constitutes an absolute contraindication. Ostium patch angioplasty of the proximal left main coronary artery should be considered a surgical alternative in selected patients.