Mid-term outcome of surgical coronary ostial plasty: Our experience

The conventional coronary artery bypass procedure that uses venous or arter ial conduit for isolated critical stenosis of the left main coronary artery (LMCA) restores a less physiological perfusion of the myocardium and uses an appreciable length of bypass material. Coronary ostial plasty has been d escribed as an alternative surgical technique in proximal obstructive coron ary artery disease without calcifications. Here we report 23 patients (15 m ales and 8 females aged 37-78 years; mean age 57 years) who underwent surgi cal ostial plasty. Ostial reconstruction with fresh pericardial patch was p erformed in all patients: 15 patients with LMCA stenosis, 6 patients with r ight coronary (RC) ostial stenosis, and 2 patients with both RC artery and LMCA stenosis. In seven cases, coronary artery bypass grafting was added fo r contralateral distal stenosis with a total of five arterial conduits and six venous grafts. One patient died; the ostial plasty and grafts were pate nt at necropsy. Thallium-201 myocardial scintigraphy under stress at 30 day s to 6 months after operation demonstrated good myocardial perfusion in 21 of 22 patients. Coronary angiography at follow-up (49 +/- 8 months) demonst rated good surgical ostial plasty results in 21 of 22 patients and good cor onary flow in 19 of 22 patients; angiographic study at mid-term follow-up r evealed only one failure of the surgical ostial plasty technique associated with venous graft obstruction. In 2 other patients CABG failure due to ven ous graft obstruction (1patient) or distal stenotic lesions of the left cor onary artery (1 patient) was noted. The overall successful outcome of the s urgical ostial plasty was 22 of 23. We believe that surgical angioplasty of the coronary ostia may be used in the presence of proximal noncalcified ob structive lesions as an alternative technique, which offers a more physiolo gical revascularization; it also spares grafting material and allows subseq uent percutaneous transluminal angioplasty or coronary artery bypass surger y.