title: Surgical angioplasty with exclusion of atheromatous plaques in case of diffuse disease of the left anterior descending artery: 2 years' follow-up.
abstract: OBJECTIVE
  A new surgical technique of coronary artery angioplasty for diffuse and extensive lesions of the left anterior descending artery (LAD) is evaluated in this study.
  
  
  METHODS
  Ninety-four coronary artery reconstructions (CAR) using a new technique of angioplasty of the LAD were performed: mean age of patients was 59+/-8 years, there were 21 patients with unstable angina, and 21 with recent myocardial infarction (MI).
  
  
  METHODS
  Diseased LAD is bypassed with the internal thoracic artery graft (ITA). The anastomosis is made downstream from the significant proximal lesion of the LAD. A long arteriotomy (from 2 to 12 cm) is performed along the LAD up to the healthy arterial wall, followed by coverage with the onlay graft of ITA in such a fashion as to exclude the plaques from the LAD lumen. The wall of the new reconstructed LAD consisted of 75% of ITA and 25% of native LAD. The remaining part of the native LAD forms a posterior gutter giving the origins of septal and diagonal branches.
  
  
  RESULTS
  aortic cross-clamping time was 116 min, operative mortality rate was 3.2% (three patients), peri-operative infarction rate 6.6% (six patients). The follow-up was 29 months (SD=10). Of the 91 survivors, two were lost for follow-up and one died of non-cardiac causes. Of the 88 patients clinically evaluated, 81 were free from angina and other cardiac events, two had new myocardial infarction in a non-grafted area, two were in congestive heart failure, and three in angina class II. Sixty patients underwent angiography. There were 57 perfect-patency CAR (95%), two ITA string sign (competitive flow), two ITA occlusions (2.5%) and no re-stenosis.
  
  
  CONCLUSIONS
  CAR allows revascularisation of diffusely diseased LAD with acceptable operative mortality and morbidity, 2 years' good clinical results and graft patency. In this series, exclusion of plaques prevented plaque complications.
authors.affiliation: Service de Chirurgie Cardiaque, Thoracique et Vasculaire, CHU Hôpital de la Cavale Blanche, 29609, Brest, France.
authors.forename: J A
authors.initials: JA
authors.lastname: Barra
authors.forename: E
authors.initials: E
authors.lastname: Bezon
authors.forename: P
authors.initials: P
authors.lastname: Mondine
authors.forename: A
authors.initials: A
authors.lastname: Resk
authors.forename: M
authors.initials: M
authors.lastname: Gilard
authors.forename: J
authors.initials: J
authors.lastname: Mansourati
authors.forename: J
authors.initials: J
authors.lastname: Boshat
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D000789:Angina, Unstable / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D003327:Coronary Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D011446:Prospective Studies; D013895:Thoracic Arteries / Q000637:transplantation*; D016896:Treatment Outcome