Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with of without endarterectomy

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.