title: Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy.
abstract: BACKGROUND
  The diffusely diseased left anterior descending coronary artery (LAD) remains a challenge for both interventional cardiologists and cardiac surgeons. In this study we assessed the surgical outcomes obtained from coronary artery reconstruction, with or without endarterectomy, for a diffusely diseased LAD.
  
  
  METHODS
  Two hundred and fifty patients were treated with an extended LAD reconstruction, with or without endarterectomy, as part of coronary artery bypass grafting to achieve complete revascularization. The left internal thoracic artery (LITA) was used to reconstruct the LAD in all patients. There were 197 men and 53 women. The mean age was 65.1 +/- 9.0 years. Coronary artery reconstruction was performed without endarterectomy in 183 patients (73.2%) and with endarterectomy in 67 patients (26.8%). The off-pump technique was used in 204 patients (81.6%).
  
  
  RESULTS
  The operative mortality was 1.6%. Perioperative myocardial infarction was observed in 6.4% of the patients. The mean LAD incision length was 4.3 +/- 1.7 cm. The patency rate of the LITA to LAD was 98.6% by early angiographic examination (mean, 7.5 +/- 2.6 postoperative days). There were 3 late cardiac-related deaths at a mean follow-up of 21.2 +/- 10.7 months. The actuarial survival was 92.0% at 45 months. Freedom from death or cardiac events was 88.1% at 45 months.
  
  
  CONCLUSIONS
  Coronary artery reconstruction, with or without endarterectomy, using the left internal thoracic artery for a diffusely diseased LAD can be performed with acceptable early and midterm results.
authors.affiliation: Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan. tm-fukui@gem.hi-ho.ne.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hosoda
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D012189:Retrospective Studies