Does operative transluminal angioplasty extend the limits of coronary artery bypass surgery? A preliminary report.

Distal coronary artery disease often reduces the feasibility and effectiveness of coronary bypass surgery to specific vessels. Operative transluminal angioplasty (OTA) is a valuable adjunct to coronary bypass surgery without significant sequelae. OTA should not be used to supplant coronary bypass; rather, if should be used to augment that procedure. We report our experience with 24 patients who underwent OTA. Twenty-nine lesions were dilated: 17 distal lesions in a primary coronary artery limiting runoff, six tandem lesions that would otherwise not warrant separate grafts, and six lesions in coronary branches and large enough to accept a bypass graft. Catheter dilatations were performed with 20-mm-long balloons inflated to an external diameter of 2-3 mm. Hand inflation monitored by direct vision for 10 second was used for dilatation. Severe stenosis prevented passage of the balloon across lesions in four cases. Stenoses in 25 lesions would not allow passage of a 0.5-1 mm probe before dilatation. After successful dilatation, passage of 1.5-2.0-mm probes was possible. Repeat cardiac catheterization was performed on eight patients 10 days to 4 months postoperatively. Seven patients improved, one did not improve, and there were no closures, extravasations or aneurysms. One hypercoagulable patient required reoperation for two early graft occlusions at 8 days. There were no perioperative infarctions or deaths.