Department of Cardiothoracic Surgery and Transplantation, University-Hospital of Nancy-Brabois, and School of Surgery, Faculty of Medicine, UHP-Nancy University, Vandoeuvre lès Nancy, France.
Ann Thorac Surg. 2010 Apr;89(4):1151-7. doi: 10.1016/j.athoracsur.2009.12.071.
Left main coronary artery (LMCA) disease is currently treated by coronary artery bypass grafting or, more recently, by percutaneous coronary intervention. Occasionally, direct surgical patch angioplasty of the LMCA can be proposed as an alternative treatment. The aim of this study was to analyze, on a long-term basis, the safety and efficacy of this technique.
This retrospective analysis was obtained from clinical data between April 1995 and December 2008: 91 consecutive patients (67 men, 24 women; mean age: 58+/-10 years) underwent surgical angioplasty of the LMCA with an autologous pericardial patch. Among them, 80 (87.9%) presented an isolated LMCA disease. Mean logistic European system for cardiac operative risk evaluation of this series was 3.9+/-2.9. Concomitant surgical procedures included coronary artery bypass grafting (n=11; 12%), valve procedure (n=5; 5.5%), and carotid endarterectomy (n=1; 1.1%). We analyzed the early and late mortality, major adverse cardiac or cerebral event rate, and repeat revascularization rate.
The mean follow-up was 7.22+/-3.60 years (maximum 13.8 years, minimum 180 days). Perioperative mortality was 1.1%. Five and ten-year global survival was 95+/-4.5% and 80+/-8.3%, respectively. Major adverse cardiac or cerebral event rates at five and ten years were, respectively, 21+/-8.4% and 31+/-9.6%. First repeat postoperative revascularization rate was 12+/-6.8% at five and 17+/-7.8% at ten years (n=10 patients). Among them, repeat target lesion revascularization concerned four patients.
Similar to other series, our study shows satisfactory long-term outcomes with the surgical patch-plasty of LMCA. This technique can be proposed as an efficient and safe alternative to selected patients, particularly in case of isolated LMCA disease without extended calcification.
左主干冠状动脉（LMCA）疾病目前的治疗方法是冠状动脉旁路移植术，或者最近是经皮冠状动脉介入治疗。偶尔，LMCA 的直接外科补丁血管成形术也可以作为一种替代治疗方法提出。本研究的目的是从长期来看分析这种技术的安全性和有效性。
这项回顾性分析是从 1995 年 4 月至 2008 年 12 月的临床数据中获得的：91 例连续患者（67 例男性，24 例女性；平均年龄：58+/-10 岁）接受了自体心包补片的 LMCA 外科血管成形术。其中，80 例（87.9%）患有孤立性 LMCA 疾病。该系列的平均逻辑欧洲心脏手术风险评估系统为 3.9+/-2.9。同时进行的手术包括冠状动脉旁路移植术（n=11；12%）、瓣膜手术（n=5；5.5%）和颈动脉内膜切除术（n=1；1.1%）。我们分析了早期和晚期死亡率、主要心脏或脑不良事件发生率以及再次血运重建率。
平均随访时间为 7.22+/-3.60 年（最长 13.8 年，最短 180 天）。围手术期死亡率为 1.1%。5 年和 10 年的总体生存率分别为 95+/-4.5%和 80+/-8.3%。5 年和 10 年时的主要心脏或脑不良事件发生率分别为 21+/-8.4%和 31+/-9.6%。5 年和 10 年时的首次再次手术后血运重建率分别为 12+/-6.8%和 17+/-7.8%（10 例患者）。其中，4 例患者再次发生目标病变血运重建。
与其他系列一样，我们的研究显示 LMCA 外科补丁成形术具有令人满意的长期结果。该技术可以作为一种有效且安全的替代方法，适用于特定患者，特别是在没有广泛钙化的孤立性 LMCA 疾病的情况下。
