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Off-pump Left Anterior Descending Coronary Artery Reconstruction Using Long Mammary Patch Without Endarterectomy In Extensive Coronary Artery Disease.
Hosam Fouad Aly Fawzy1, Khaled Abdullah
2.
1Alhada Hospital, Taief, Saudi Arabia,
2National Guard Hospital, Ryiadh, Saudi Arabia.
Objective: Surgery for diffuse coronary artery disease requires coronary reconstruction with or without endarterectomy. Considering the immediate and late complications of coronary endarterectomy, many surgeons now prefer coronary reconstruction without endarterectomy. Patch reconstruction of the diseased coronary artery with internal mammary artery is an attractive option. This study describes the technique of long mammary patch reconstruction of the left anterior descending coronary artery without endarterectomy on beating heart.
Methods: Between April 2019 and April 2024, 50 patients underwent CABG with long patch LAD reconstruction (≥ 3 cm) without endarterectomy using the LIMA. The mean age of the patients was 59.07 ± 8.79 Years. Of these patients, 41 (82%) were male, 35 (70%) were diabetics, 37 (74%) were hypertensive, 20 (40%) were smokers, 30 (60%) has dyslipidaemia and 25 (50%) had a history of a previous myocardial infarction preoperatively. Multi-slice computed tomography (MSCT) coronary angiography was done six months postoperative to assess the patency of LAD reconstruction. Patients' follow-up time was between 1-5 years.
Results: All patients underwent complete revascularization. The total number of grafts was 145. Mean number of anastomoses done per patient was 3 ± 0.9 (range 2-4 grafts). One patient (2%) needed conversion from off pump to on pump due to intractable ventricular fibrillation. Four patients (8%) had post-op low cardiac output syndrome: two (4%) required an intraaortic balloon pump. Two (4%) patients required re-exploration for bleeding. The mean (ICU) stay was 2.5 ± 1.2 days and the overall length of stay (LOS) was 7. 5 days ± 2.5 days. There was no mortality within the 30 days but one patient expired after two months because of COVID pneumonia. During follow up: three patients (6%) had typical chest pain: One patient (2%) required PCI with LCX stenting and two (4%) were managed medically. Follow up MSCT coronary angiograms was done in the remaining 49 patients (98%) showed full patent reconstructed LAD patch in all of them.
Conclusions: Off-pump long patch LAD reconstruction without endarterectomy using LIMA is technically demanding but possible with excellent results in the immediate and intermediate follow up.
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