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Ann Thorac Surg 2001;72:976-977
© 2001 The Society of Thoracic Surgeons

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Correspondence

The role of endarterectomy and TMR in diffuse coronary artery disease

^a Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr. J. Jayalalitha Nagar, Mogappair, Chennai 600 050, India

e-mail: icvd{at}eth.net

To the Editor

We read with interest the article by Ferraris and associates [1], which brings to the forefront two important issues in the surgical management of patients with diffuse coronary artery disease.

The first issue regards the use of internal mammary artery after endarterectomy of left anterior descending artery. We tend to agree with their opinion that coronary endartectomized (CE) patients have more advanced disease compared with non-CE patients. However, it is fairly advantageous to use LIMA onlay patch even after extensive endarterectomy, and 69 of such cases were reported in 1996 [2].

The second issue relates to the use of transmyocardial laser revascularization (TMLR) in these patients. Despite endarterectomy and bypass grafting of diffusely diseased vessel, often there remains viable but ischaemic myocardium supplied by ungraftable vessels. Transmyocardial laser revascularization over these areas, along with endarterectomy and bypass grafting, aims at complete revascularization. In all, 44 cases of coronary artery bypass and endarterectomy combined with transmyocardial laser revascularization have been reported by us [3].

Analysis of our results has shown that endarterectomy of diffusely diseased coronary arteries capable of accepting a bypass graft, combined with creation of laser channels in areas where a bypass graft could not be used, is a promising alternative in this subset of patients. A significant percentage of our patients have diffuse coronary artery disease with small-caliber vessels that are amenable to conventional revascularization, and we continue to use this combined approach with good clinical results.

References

1. Ferraris V.A., Harrah J.D., Moritz D.M., Striz M., Striz D., Ferraris S.P. Long-term angiographic results of coronary endarterectomy. Ann Thorac Surg 2000;69:1737-1743.[Abstract/Free Full Text]
2. Sankar N.M., Satyaprasad V., Rajan S., Bashi V.V., Cherian K.M. Extensive endarterectomy, onlay patch and internal mammary bypass of the left anterior descending coronary artery. J Card Surg 1996;11:56-60.[Medline]
3. Cherian KM, Agarwal R, Madhu Sankar N. Transmyocardial laser revascularisation. Advances in cardiac surgery. St. Louis, MO: Mosby, Inc, 1999;11:55–68.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cherian, K.M. Articles by Madhu Sankar, N. Search for Related Content PubMed Articles by Cherian, K.M. Articles by Madhu Sankar, N. Related Collections Coronary disease Related Article