Left anterior descending endarterectomy and internal thoracic artery bypass for diffuse coronary disease.

BACKGROUND

The risk and efficacy of using an arterial conduit to bypass an endarterectomized coronary artery remain incompletely defined. To address this question we analyzed retrospectively 74 patients from 1989 to 1994 in whom bypass grafting using the left internal thoracic artery to an endarterectomized left anterior descending artery was performed.

METHODS

There were 60 men and 14 women with a mean age of 60.1 +/- 8.6 years. Of this cohort, 55 patients (74.3%) had a previous infarction, 18 (24.3%) were diabetic, and 5 (6.7%) had reoperations; 25 patients (34%) had a totally occluded left anterior descending artery and the average ejection fraction was 45%. Each patient had 2.95 +/- 0.52 grafts with 48 patients (65%) requiring multiple endarterectomies. The average length of the endarterectomized segment was 3.1 +/- 1.6 cm. Average anoxia time was 49 +/- 13 minutes. Postoperatively 19 patients (25.6%) required intraaortic balloon and 18 (24.3%) required inotropic support. Perioperative infarction in the left anterior descending artery distribution occurred in 5 patients (6.7%).

RESULTS

There were 3 (4.0%) early and 4 (5.4%) late deaths at a mean follow-up of 36 +/- 16 months. Recurrent angina was present in 9 patients (14.7%). Actuarial 5-year survival was 84.5%. Angiographic follow-up obtained in 23 patients (37.4%) demonstrated 74% anastomotic patency, with good distal run-off in 13 (65%). The anterior segmental wall motion was preserved.

CONCLUSIONS

The use of the left internal thoracic artery bypass and adjunctive left anterior descending artery endarterectomy to expand the scope of myocardial revascularization in carefully selected circumstances appears to be beneficial.