%0 Journal Article %T Emergency Surgical Treatment for the Total Occlusion of the Left Main Coronary Artery: A Case Report %J Iranian Heart Journal %I Iranian Heart Association %Z %A Safarpoor, Gholamreza %A Emami, Farzad %A Shams, Amir %A Keshavari, Sheida %A Moeinipour, Aliasghar %A Manafi, Babak %D 2018 %\ 09/01/2018 %V 19 %N 3 %P 64-67 %! Emergency Surgical Treatment for the Total Occlusion of the Left Main Coronary Artery: A Case Report %K Left main coronary artery obstruction %K Myocardial Infarction %K Cardiogenic shock %K Early revascularization %K Coronary artery bypass surgery %R %X Background: The acute occlusion of the left main coronary artery (LMCA) in the absence of the collateral circulation is extremely rare, but it remains a catastrophic and mostly fatal entity due to myocardial infarction with severe cardiogenic shock and arrhythmias. Methods: We evaluated 2 patients with an acute or acutely evolving occlusion of the LMCA undergoing coronary artery bypass grafting (CABG). Results: The in-hospital mortality rate was 50%. Revascularization was achieved with on-pump CABG in both patients. Conclusions: The total occlusion of the LMCA represents a unique clinical condition. The LMCA occlusion with shock is regarded as a class IA indication for acute surgical revascularization. Nonetheless, emergent percutaneous coronary intervention (PCI) may be an effective method to acutely revascularize these patients. Additionally, aggressive post-PCI care—including intra- aortic balloon pumps, extracorporeal membrane oxygenation, CABG, and ventricular support devices—may be required to improve patient survival. (Iranian heart Journal 2018; 19(3): 64- 67) %U http://journal.iha.org.ir/article_83108_b26393144d2af73e6df4264a203801db.pdf