LEFT ANTERIOR DESCENDING ENDARTERECTOMY AND INTERNAL THORACIC ARTERY BYPASS FOR DIFFUSE CORONARY-DISEASE

Background. The risk and efficacy of using an arterial conduit to bypa ss an endarterectomized coronary artery remain incompletely defined. T o address this question we analyzed retrospectively 74 patients from 1 989 to 1994 in whom bypass grafting using the left internal thoracic a rtery to an endarterectomized left anterior descending artery was perf ormed. Methods. There were 60 men and 14 women with a mean age of 60.1 +/- 8.6 years. Of this cohort, 55 patients (74.3%) had a previous inf arction, 18 (24.3%) were diabetic, and 5 (6.7%) had reoperations; 25 p atients (34%) had a totally occluded left anterior descending artery a nd the average ejection fraction was 45%. Each patient had 2.95 +/- 0. 52 grafts with 48 patients (65%) requiring multiple endarterectomies. The average length of the endarterectomized segment was 3.1 +/- 1.6 cm . Average anoxia time was 49 +/- 13 minutes. Postoperatively 19 patien ts (25.6%) required intraaortic balloon and 18 (24.3%) required inotro pic support. Perioperative infarction in the left anterior descending artery distribution occurred in 5 patients (6.7%). Results. There were 3 (4.0%) early and 4 (5.4%) late deaths at a mean follow-up of 36 +/- 16 months. Recurrent angina was present in 9 patients (14.7%). Actuar ial 5-year survival was 84.5%. Angiographic follow-up obtained in 23 p atients (37.4%) demonstrated 74% anastomotic patency, with good distal run-off in 13 (65%). The anterior segmental wall motion was preserved . Conclusions. The use of the loft internal thoracic artery bypass and adjunctive left anterior descending artery endarterectomy to expand t he scope of myocardial revascularization in carefully selected circums tances appears to be beneficial. (C) 1998 by The Society of Thoracic S urgeons.