DEPARTMENT OF CARDIAC SURGERY, RAJAI CARDIOVASCULAR, MEDICAL AND RESEARCH CENTER
Background- Long-segment reconstruction of the diffusely diseased left anterior descending artery (LAD) with left internal thoracic artery (LITA) is one of the methods offered in order to deal with complicated, multiple, and long-segment lesions in the LAD. In this prospective study, we analyzed the results obtained with this technique.
Methods- Between Feb. 2007 and Feb. 2009, 56 patients underwent surgery via this technique. The LITA was used as a patch along the opened narrow segment of the LAD from 2 to 8 cm. Data on all the patients were collected, and all the patients were worked up for postoperative complications such as postoperative myocardial infarction, ECG changes, NIHA class, enzymatic changes, and postoperative bleeding. CT-Angiography was performed between 6 to 18 months after surgery in some cases.
Results- Fifty-six cases, comprising 42 (75%) men and 14 (25%) women between 43 and 78 years of age (mean age=59.8±9.3 years) with multiple and long-segment lesions in the LAD were included in this study. Preoperative risk factors were hypertension (66.1%), diabetes (57.1%), hyperlipidemia (50%), cigarette smoking (50%), renal failure (1.8%), and positive family history (7.1%). Twenty-three (41.1%) patients had remote and 9 (16.1%) had recent myocardial infarction. Significant left main lesions were found in 7 (12.5%) patients, peripheral vascular disease in 3 (5.3%), and preoperative arrhythmias in 2 (3.6%). The mean number of grafts was 2.85±1.5. Postoperative complications were arrhythmias in 10 (17.8%) patients, postoperative myocardial infarction in 1 (1.8%), surgical bleeding in 7 (12.5%), infections in 3 (5.3%), plural effusion in 3 (5.3%), tamponade in 2 (3.6%), and pericardial effusion in 1 (1.8%); there was no mortality amongst the patients. CT-angiography, performed in 6 patients between the six and eighteenth postoperative months, revealed patent anastomoses in all the patients.
Conclusion- Long segment and multiple lesions in the LAD pose a challenge for cardiac surgeons. The results of long-segment LAD reconstruction using the LITA are very encouraging.