[Significance of coronary artery bypass grafting to totally occluded left anterior descending coronary artery].
The comparative studies on operative and hemodynamic results following coronary artery bypass grafting (CABG) were performed in 15 patients with totally occluded left anterior descending coronary artery (TOLAD) and 24 with partially occluded LAD (POLAD). There were two operative deaths and one whose graft was obstructed in POLAD. Four patients were revealed to have transmural myocardial infarction (TMI) in the region other than anterior segment on the preoperative electrocardiogram. Following results were obtained in 13 TOLAD (Group I) and 19 POLAD (Group II) with two subgroups, a: without TMI and b: with anterior TMI, whose all bypass grafts were patent. Left ventricular ejection fraction, Mean Vcf and left ventricular anterior, apical segmental wall motion significantly increased postoperatively in all groups, whereas postero-inferior segmental wall motion did not increase in all groups. Cardiac index and PLVSP/LVESV significantly increased postoperatively in all groups, but did not in Group Ib. Angina disappeared postoperatively in 12 patients (92.3%) in group I and 16 (84.2%) in Group II. In both groups, NYHA classification was improved from class III or IV preoperatively to class I or II postoperatively. Postoperative 10 years actuarial survival rate was 90.7% in Group I and 90.8% in Group II. In conclusion, it was proved that CABG to TOLAD offered significant increase in left ventricular contractility, better quality of life and satisfactory long term survival rate almost same as CABG to POLAD.
Nagaoka
H
H
Innami
R
R
Yoshida
T
T
Watanabe
M
M
Hirooka
K
K
Sato
M
M
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction