Dion R, Verhelst R, Matta A, Rousseau M, Goenen M, Chalant C
Department of Cardiovascular and Thoracic Surgery, Université Catholique de Louvain, Cliniques Universitaires St. Luc, Brussels, Belgium.
J Thorac Cardiovasc Surg. 1990 Feb;99(2):241-9; discussion 249-50.
The conventional surgical treatment of isolated critical stenosis of the left main coronary artery restores a less physiologic perfusion of the myocardium, leads to occlusion of the left coronary ostium, and consumes an appreciable length of bypass material. Starting in June 1985, 23 surgical angioplasties have been performed in 22 patients. The left main stem was approached posteriorly in the first 11 patients, and an anterior approach was preferred in the last 12 because of better exposure. The onlay patch consisted of saphenous vein in the first 14 patients; pericardium was preferred in the last nine. The five failures occurred early. Four of these occurred in patients older than 60 years in whom calcifications of the left main stem had been seen on the preoperative angiogram. Eighteen procedures (78.3%) succeeded, but one patient (5.5%) died later of a massive air embolism. The 17 survivors are free of symptoms (maximal stress test combined with thallium scintigraphy) after a mean follow-up of 24.3 months. Angiographic restudy at an average of 8 months was obtained in 14 patients (82.3%) and revealed an excellent result in 13. In five patients, a late angiographic restudy (22 to 37 months) still revealed perfect patency of the left main stem. Provided that well-defined contraindications (calcifications, involvement of the distal bifurcation, older age) are respected, surgical angioplasty deserves a place in the array of surgical strategies.
孤立性左主冠状动脉严重狭窄的传统外科治疗会使心肌灌注恢复到不太符合生理状态的水平，导致左冠状动脉口闭塞，并消耗相当长一段搭桥材料。从1985年6月开始，已对22例患者实施了23次外科血管成形术。前11例患者采用后路进入左主干，后12例因暴露更好而优先采用前路。前14例患者的覆盖补片采用大隐静脉；后9例则优先选用心包。5例手术失败发生在早期。其中4例发生在60岁以上的患者中，术前血管造影显示左主干有钙化。18例手术（78.3%）成功，但1例患者（5.5%）后来死于大量空气栓塞。17名幸存者在平均随访24.3个月后无症状（最大负荷试验联合铊闪烁扫描）。14例患者（82.3%）平均在8个月时进行了血管造影复查，其中13例结果良好。5例患者进行了晚期血管造影复查（22至37个月），结果仍显示左主干通畅良好。只要遵循明确的禁忌证（钙化、远端分叉受累、年龄较大），外科血管成形术在一系列外科治疗策略中值得占有一席之地。
