Arterial patch angioplasty for reconstruction of proximal coronary artery stenosis

Background. Ostium patch angioplasty and reconstruction with an onlay patch consisting of pericardium or the saphenous vein is an alternative surgical technique for patients with proximal coronary artery stenosis. Previously described surgical techniques comprise anterior or posterior approaches. In this article we report our experience of using a segment of the proximal r ight internal mammary artery as an onlay patch for surgical angioplasty. Methods. Between June 1997 and April 1999, 18 patients (9 men and 9 women) were subjected to surgical patch angioplasty of the left main coronary arte ry, 3 patients had an additional angioplasty performed on the proximal righ t coronary artery. The first 12 patients were operated with a posterior inc ision technique, and six subsequent patients by a new technique performed t hrough an oblique incision into the left main stem after transsection of th e ascending aorta. Results. All patients had an uneventful postoperative course, and were full y rehabilitated without clinical symptoms of ischemic heart disease at mean follow-up of 10 months (range 1-23 months). Postoperative catheterization after six days showed excellent results with a widely open and funnel-shape d neoostium. Conclusions. The use of a proximal segment of the right internal mammary ar tery as an onlay patch for reconstructing proximal coronary artery lesions is safe with no complications. Although the posterior approach may be used to obtain excellent results, transsection of the ascending aorta gives an o ptimal visualization and mobilization of the left main coronary artery when performing surgical angioplasty. (C) 1999 by The Society of Thoracic Surge ons.