Coronary artery reconstruction for extensive coronary disease: 108 patients and two year follow-up

Background. Surgical coronary artery reconstruction for diffuse coronary di sease is described and assessed. Methods. A long arteriotomy, internal thoracic artery graft, and exclusion of atheromatous plaques from the coronary lumen are the bases of the techni que. One hundred eighteen reconstructions were performed in 108 patients wi th a mean age of 59 years. Stable angina was present in 62% of patients and unstable angina in 22%. Sixteen percent had had a recent myocardial infarc tion. The reconstructions involved 94 left anterior descending coronary art eries, 17 marginal, 5 diagonal, and 2 right coronary arteries. Results. The perioperative mortality rate was 3.7% (4 patients). The rate o f perioperative myocardial infarction was 6.3%. Mean follow-up was 29 month s (standard deviation, 10 months). Two patients were lost to follow-up. Nin ety patients were free from angina and cardiac-related events. Five patient s sustained a myocardial infarction, 3 were in congestive heart failure, 3 had class II angina, and 1 died of stroke. Seventy-four of the surgical cor onary artery reconstructions have been angiographically evaluated (29 month s): 94.6% of the internal thoracic artery grafts were completely patent, an d 70 of the reconstructions were patent without restenosis. String signs an d occlusions were present in two internal thoracic arteries each. Conclusions. This technique allows revascularization of severely and diffus ely diseased coronary arteries with encouraging results. (Ann Thorac Surg 2 000;70:1541-5) (C) 2000 by The Society of Thoracic Surgeons.