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Ann Thorac Surg 2006;81:1249-1255
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Follow-Up of Patients Operated on With Arterial Patch Angioplasty of the Left Main Coronary Artery

Anders Jönsson, MDa,*, Jens Jensen, MD, PhDb, Arne Olsson, MDc, Peter Holm, MD, PhDa, Jan Liska, MD, PhDa

a Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Solna, Sweden
b Department of Cardiology, Karolinska University Hospital, Solna, Sweden
c Department of Clinical Physiology, Karolinska University Hospital, Solna, Sweden

Accepted for publication November 21, 2005.

* Address correspondence to Dr Jönsson, Karolinska University Hospital, Department of Cardiothoracic Surgery and Anesthesiology, SE-171 76 Solna, Sweden (Email: anders.l.jonsson{at}karolinska.se).

Background: Surgical angioplasty of the left main coronary artery (LMCA) can be performed with good results in selected patients. It restores the native antegrade blood flow in the LMCA and does not leave the patient with a graft-dependent retrograde perfusion. By using a proximal segment of the right internal mammary artery as patch material, we assumed that this would minimize the risk of restenosis of the LMCA. We here review our experience and results.

Methods: Forty-three patients were operated on with LMCA angioplasty from 1997 to 2003. Follow-up at a mean of 45 months (range, 7 to 79) included a stress test, echocardiography, and angiography with intravascular ultrasound (IVUS) of the LMCA.

Results: There were three late deaths, none related to failure of the angioplasty. All patients included in the follow-up had preserved preoperative left ventricular function, and there was no aortic incompetence. The angioplasties investigated were patent, and no signs of restenosis or dilatation could be observed. The dimensions of the LMCA after angioplasty was in diameter 4.8 mm (3.35 to 6.75 mm) and 5.6 mm (4 to 7.6 mm), and in area 18.9 mm2 (12.3 to 31.9 mm2) and 24.8 mm2 (14.5 to 37 mm2) in the distal and proximal parts, respectively.

Conclusions: Surgical angioplasty of the left main coronary artery using a proximal segment of the right internal mammary artery as an onlay patch is safe, with good long-term results.




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