title: Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch.
abstract: BACKGROUND
  Isolated stenosis of the left main coronary artery is usually treated by coronary bypass surgery. However, this approach restores a less physiologic perfusion of the myocardium that leads to occlusion of the left main coronary artery, and restores only a retrograde perfusion of a rather extensive myocardial area. Coronary ostial plasty has been described as an alternative surgical technique in isolated ostial left main coronary artery stenosis without calcification. We review our experience with 15 patients.
  
  
  METHODS
  After placing the patient on cardiopulmonary bypass and aortic cross clamping, the main pulmonary trunk was retracted laterally. The left main coronary artery was approached anteriorly through a curved aortotomy. Reconstruction was performed using fresh pericardial patch or saphenous vein that was tailored as a patch.
  
  
  RESULTS
  There were no early mortality or perioperative myocardial infarctions. During mean follow-up of 55 +/- 39 months, no patients had any cardiac events or required repeated coronary intervention. All patients underwent follow-up transesophageal echocardiography, which demonstrated a wide open left main coronary artery (range 3 to 8 mm), normal flow pattern by pulsed-wave Doppler, and no aneurysmal dilatation or calcification of the onlay patch. Coronary angiography and intravascular ultrasound were performed in 2 patients because of nonspecific chest discomfort. In both cases, the left main coronary artery was found to be wide open, and there were no signs of patch calcification.
  
  
  CONCLUSIONS
  Surgical reconstruction of the left main coronary artery is safe and effective for the treatment of selected cases of isolated left main stenosis. The use of autologous pericardium appears to be as safe as saphenous vein patch. Neither method was associated with postoperative aneurysmal dilatation or calcification.
authors.affiliation: Department of Cardiothoracic Surgery, Tel Aviv, Israel. ehud.raanani@sheba.health.gov.il
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Alexander
authors.initials: A
authors.lastname: Kogan
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Alex
authors.initials: A
authors.lastname: Sagie
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowsky
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Vidne
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015897:Comorbidity; D023921:Coronary Stenosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency