[Coronary revascularization using only arterial grafts in patients with left main coronary artery stenosis].

Although increasing use is being made of arterial grafts (internal thoracic arteries and right gastroepiploic artery) for coronary revascularization, application to left main coronary artery (LMT) patients is frequently not possible. During the period from December 1989 to July 1991, coronary revascularization was conducted on 9 LMT patients using only arterial grafts and no venous grafts. The bypass grafts were 6 left internal thoracic artery grafts, 9 right internal thoracic artery grafts and 9 right gastroepiploic artery grafts, a total of 24 grafts and an average of 2.7 bypasses per patient. There were no operated deaths, but five patients required IABP support after cardiopulmonary bypass. They had more than 90% stenotic lesions of left main coronary artery. In contrast, four patients with less than 90% stenotic lesion were uneventful. The cause of these catastrophic hemodynamics was considered reduced blood flow by graft spasm. All patients could be functionally placed in New York Heart Association Class I or II. Postoperative stress tests were made on eight patients and the results were normal in seven. Eight patients have had postoperative angiograms. Twenty-one of 22 grafts were patent. The present results demonstrate that an arterial bypass is possible even on LMT patients by IABP support.