title: Surgery for chronic total occlusion of the left main coronary artery--myocardial preservation.
abstract: We report seven patients with chronic total occlusion of the left main coronary artery that were operated in our institution and discuss the myocardial preservation options in these patients. In addition to total occlusion of the left main coronary artery, three patients also had severe lesions of right coronary artery. Prior myocardial infarction history and significantly depressed left ventricle functions were detected in all three patients with right coronary artery lesions. Five patients were operated on cardiopulmonary bypass while two patients were operated off pump. All patients received alternating antegrade/retrograde cardioplegia for myocardial preservation. In patients with simultaneous right coronary artery disease we first established the origin of the collaterals to the left coronary system. For patients with collaterals arising from the right coronary artery segment distal to the right coronary artery lesion, the antegrade component was administered through the saphenous vein graft bypassed to a distal part of right coronary artery segment. Thus we have achieved a more effective distribution of the antegrade cardioplegia. In off-pump-operated patients the left coronary system was revascularized before the right coronary system. Postoperative low cardiac output syndrome occurred in only one patient who was operated off pump. There was no operative and early mortality. Mean follow-up was 32 +/- 21.42 (range, 4 to 60) months. Alternating antegrade/retrograde cardioplegia was used with acceptable results in patients with total occlusion of the left main coronary artery. In patients with simultaneous RCA lesion we recommend regulation of the antegrade component based on the origin of collaterals that supplies the left coronary system. In off-pump-operated patients we suggest avoiding of clamping of right coronary artery at the beginning of the operation while it still supplies all the coronary circulation.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ipek
authors.forename: Suat Nail
authors.initials: SN
authors.lastname: Omeroglu
authors.forename: Hasan
authors.initials: H
authors.lastname: Ardal
authors.forename: Denyan
authors.initials: D
authors.lastname: Mansuroglu
authors.forename: Nihan
authors.initials: N
authors.lastname: Kayalar
authors.forename: Mesut
authors.initials: M
authors.lastname: Sismanoglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Guler
authors.forename: Bahadir
authors.initials: B
authors.lastname: Daglar
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions