Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery.

BACKGROUND

We performed long segmental reconstruction of the left anterior descending coronary artery (LAD) using the left internal thoracic artery (LITA) in patients with diffusely diseased coronary arteries. Our study investigated short- and long-term outcomes and angiographic results after complete revascularization using this technique.

METHODS

Between March 1995 and March 2001, 112 patients (mean age 63 years) underwent long segmental LAD reconstruction (≥2 cm) with or without endarterectomy using the LITA. Of these, 68 patients (61%) had a history of old myocardial infarction, 44 (39%) had undergone prior percutaneous coronary intervention, 39 (35%) had unstable angina, and 11 (10%) required preoperative intraaortic balloon pumping.

RESULTS

The majority of patients (96%) underwent operation under cardiac arrest. All patients underwent a complete revascularization with long segmental LAD reconstruction using the LITA. The average length of arteriotomy was 3.7 cm, and 43 patients (38%) underwent extensive (≥4 cm) LAD reconstruction. Endarterectomy was performed in 37 patients (33%). The early mortality rate was 1.8% (2 of 112). Perioperative myocardial infarction in the LAD territory was 5.4%. The 5- and 10-year survival rates were 91% and 74%, respectively. Freedom from major adverse cardiac events at 10 years was 77%. Early angiography (n = 99) showed a 99% excellent patency rate of the LITA. Midterm (n = 61) and long-term (n = 23) follow-up angiography both showed 100% excellent patency rate of the LITA.

CONCLUSIONS

Long segmental LAD reconstruction with or without endarterectomy using the LITA provided excellent long-term outcomes and acceptable early operative results, even in patients with diffusely diseased coronary arteries.