Ja. Barra et al., Surgical angioplasty with exclusion of atheromatous plaques in case of diffuse disease of the left anterior descending artery: 2 years' follow-up, EUR J CAR-T, 17(5), 2000, pp. 509-513
Objective: A new surgical technique of coronary artery angioplasty for diff
use and extensive lesions of the left anterior descending artery (LAD) is e
valuated in this study. Method: Ninety-four coronary artery reconstructions
(CAR) using a new technique of angioplasty of the LAD were performed: mean
age of patients was 59 +/- 8 years, there were 21 patients with unstable a
ngina, and 21 with recent myocardial infarction (MI). Surgical technique: D
iseased LAD is bypassed with the internal thoracic artery graft (ITA). The
anastomosis is made downstream from the significant proximal lesion of the
LAD. A long arteriotomy (from 2 to 12 cm) is performed along the LAD up to
the healthy arterial wall, followed by coverage with the onlay graft of ITA
in such a fashion as to exclude the plaques from the LAD lumen. The wall o
f the new reconstructed LAD consisted of 75% of ITA and 25% of native LAD.
The remaining part of the native LAD forms a posterior gutter giving the or
igins of septal and diagonal branches. Results: aortic cross-clamping time
was 116 min, operative mortality rate was 3.2% (three patients), peri-opera
tive infarction rate 6.6% (six patients). The follow-up was 29 months (SD =
10). Of the 91 survivors, two were lost for follow-up and one died of non-
cardiac causes. Of the 88 patients clinically evaluated, 81 were free from
angina and other cardiac events, two had new myocardial infarction in a non
-grafted area, two were in congestive heart failure, and three in angina cl
ass II. Sixty patients underwent angiography. There were 57 perfect-patency
CAR (95%), two ITA string sign (competitive how), two ITA occlusions (2.5%
) and no re-stenosis. Conclusions: CAR allows revascularisation of diffusel
y diseased LAD with acceptable operative mortality and morbidity, 2 years'
good clinical results and graft patency. In this series, exclusion of plaqu
es prevented plaque complications. (C) 2000 Elsevier Science B.V. All right
s reserved.