SURGICAL ANGIOPLASTY OF THE CORONARY TRUNKS - AN ALTERNATIVE TO BYPASS TECHNIQUES

Aim: To test the value of surgical angioplasty of the coronary trunks as an alternative to bypass techniques. Patients and methods: Surgical angioplasty of the coronary trunks was performed in 12 patients (mean age 59+/-9 years), of whom nine underwent right coronary trunk angiop lasty, five underwent left main coronary artery angioplasty, and two p atients underwent bilateral coronary trunk angioplasty. A transpulmona ry approach to the left main coronary artery was used. The patch consi sted of saphenous vein in the first two patients but in the rest peric ardium was preferred. Associated bypass procedures to the other corona ry network using internal mammary or gastroepiploic arteries were perf ormed in six patients, and one patient had a concomitant aortic valve replacement. Results: No early mortality (30-day) or morbidity was obs erved and all procedures were successful. A 15-day angiographic study revealed an excellent result in all 14 angioplasties. After 6 months, all patients were free of symptoms during exercise stress testing (max imum level of exercise 140+/-20 W). One patient with a recurrence of a ngina underwent a second operation after 1 year because of left anteri or descending coronary artery occlusion after bilateral angioplasty. A nother angiographic study was obtained after 1 year in three other pat ients, which showed excellent results (four angioplasties controlled). After a mean follow-up period of 17+/-7 months (range 6-31), all pati ents were symptom-free, and with the exception of the one reoperation, no cardiac events were reported. Conclusions: Provided that contraind ications (calcifications, involvement of the distal bifurcation) are r espected, surgical angioplasty of the coronary trunks is safe, restore s physiologic coronary perfusion, is economical with bypass material, and provides good results.