Surgical treatment of the isolated left ostial stenosis.
OBJECTIVE
Conventional grafting for left main coronary artery (LMCA) stenosis provides a retrograde perfusion to extensive myocardial area, leads prospectively to totally occlusion of the LMCA and to competitive flow of the non-occluded coronaries thus consuming the grafts. Surgical reconstruction of the LMCA with patch-angioplasty is an alternative method that eliminates these drawbacks.


METHODS
Between February 1997 and August 2009, 45 patients with isolated LMCA stenosis were referred for surgical ostial reconstruction. In 32 patients (71%) surgical angioplasties have been performed. All patients were followed-up clinically and with transesophageal echocardiography (TEE) and coronary angiography when required.


RESULTS
In 13 patients (29%) a LMCA stenosis could not be confirmed. There were no early mortality or perioperative myocardial infarctions. The postoperative course was uneventful in all patients. In 30 patients, TEE demonstrated a wide open main stem flow pattern one to six months after reconstruction of the left main coronary artery with one patch mild aneurysmal dilated.


CONCLUSIONS
The results after surgical reconstruction with patch-angioplasty are good and comparable with those after CABG. The endarterectomy and reconstruction should be avoided in the case of distal stenosis of LMCA and excessive calcification. Almost one third of the study group had no really LMCA stenosis. These patients have benefited of the plan to perform a reconstruction: antegrade flow pattern remained sustained and the arterial grafts have been spared.
Department of Cardiothoracic Surgery, Philipps University Marburg, Marburg, Germany. martinov@med.uni-marburg.de
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Martinovic
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Greve
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome