Surgical treatment of left main coronary artery disease: operative risk.

Surgical experience with 100 consecutive patients with left main coronary artery stenosis (greater than 50%) was reviewed to determine the risk factors and their relationship to preoperative use of intraaortic balloon (IAB). The 30-day mortality rate was 3% and the perioperative infarction rate was 2%. There was no correlation between surgical mortality and ejection fraction (EF) (15% had EF of less than 40%), degree of stenosis (58% of the patients had greater than 70% left main stenosis), right coronary artery stenosis (81%), or the number of grafts placed. We conclude that surgery for left main coronary artery disease can be done with a low mortality rate by strict attention to the induction of anesthesia, surgical technique, and complete revascularization. In our experience, prophylactic use of the IAB does not appear to be justified and is only rarely necessary for postoperative support (one case).