LONG-TERM RESULTS OF RECONSTRUCTIONS OF THE LEFT ANTERIOR DESCENDING CORONARY-ARTERY IN DIFFUSE ATHEROSCLEROTIC LESIONS

One hundred twenty patients who had diffuse atherosclerotic lesions ne cessitating reconstruction of the left anterior descending artery with or without open endarterectomy and coronary artery bypass grafting we re investigated retrospectively and compared with 130 patients who und erwent conventional bypass grafting in the same time frame. Methods: S ixty-one endarterectomies were performed with long arteriotomies (grou p I) and 59 patch reconstructions were placed over stenosing plaques w ithout an endarterectomy (group II). Patients having only conventional coronary bypass constituted group III. Results: Hospital mortalities were 6.5%, 5.1%, and 1.5% in group I, group II, and group III, respect ively (p = not significant). Five patients in group I (8.1%), six in g roup II (10.1%), and two in group III (1.5%) had perioperative myocard ial infarction (group II vs group III, p = 0.016). Angiographic restud y of grafts to the left anterior descending system revealed a patency rate of 81.5% in group I, 79.1% in group II, and 93.3% in group III pa tients after mean periods of 6.3, 5.7, and 6.1 years, respectively (p = not significant). Actuarial survivals at 7 years were 93% +/- 5.0%, 74.8% +/- 16%, and 90.9% +/- 7.4% in groups I, II, and III, respective ly (group I vs group II, p = 0.007; group II vs group III, p = 0.008). Freedom from recurrent angina at 7 years was 42.7% +/- 15.6% in group I, 33.5% +/- 19% in group II, and 71.9% +/- 14.2% in group III (group I vs group III, p = 0.03; group II vs group III, p = 0.0001). Thirty- four percent of patients in group I, 24% in group II, and 60.4% in gro up III were working actively in the late postoperative period (p = 0.0 001). Conclusion: Extended revascularizations of the left anterior des cending coronary artery increase surgical risk, although not to a stat istically significant degree, and should be performed only of necessit y. However, once needed, revascularization is a lifesaving procedure w ith acceptable early and long-term results.