Complete revascularization of the left anterior descending coronary artery.

OBJECTIVE

To assess the efficacy of complete revascularization of the left anterior descending coronary artery.

METHODS

To obtain such revascularization, 81 patients required the use of such complex techniques as the onlay patch technique or double bypasses during bypass grafting.

RESULTS

The onlay patch technique was used in 39 (48%) and double bypasses in 42 (52%). The wall motion in all anterior segments of the left ventricle showed an improving trend postoperatively. The patency rate was 99% overall, and the bypass grafts to the left anterior descending coronary artery were all patent with flow in all left anterior descending coronary artery areas. Perioperative myocardial infarction occurred in only 1 patient (1.2%), and hospital mortality was 2.5% (2/81). Long-term results of 79 hospital survivors were as follows: the mean follow-up time was 77 months (3 to 236); the actuarial survival rate including all deaths and estimated by cardiac death was 90% and 95% at the eighth postoperative year respectively; the cardiac event free rate at the fifth and eighth postoperative year was 90% and 63% respectively. A total of 8 cardiac events were observed. Excluding 3 cardiac deaths, no cardiac events were clearly attributable to the left anterior descending coronary artery.

CONCLUSIONS

Complete revascularization of the left anterior descending coronary artery using these techniques improved the anterior wall motion in the left ventricle and cardiac performance at low risk, and provided excellent long-term results.