Search

Left main coronary artery disease (LMCAD) is a particularly severe form of coronary artery disease (CAD); its frequency ranges from 5% of 7% in patients with CAD [4, 6, 7] and virtually all published reports show a grim natural history: the survival rate of medically treated patients with LMCAD ranges from 65% to 57% at 2 years [9, 16], from 49% to 46% at 5 years [3, 13], and from 13% to 31% after 10 years [19]. Coronary artery bypass grafting (CABG) is generally accepted as the treatment of choice in these patients and randomized studies of large series have shown a significantly better prognosis for the operated patients, with 88% or 86% survival at 4 years [5, 7]. The data obtained from our experience with 155 consecutive cases of LMCAD treated by CABG form the basis of this report.

At present, for most patients with coronary artery disease (CAD), coronary artery bypass grafting (CABG) is the therapy which offers the best control of symptoms and, in many cases, longer survival. Although an improvement in clinical status can be achieved in most patients treated with CABG, angina may persist in operated on patients or may appear later in the postoperative course.

From July 1981 to June 1987 160 consecutive patients underwent left ventricular (LV) septoplasty for LV aneurysm involving the septum. LV septoplasty affords reconstruction of LV septum by means of a series of stitches passed from the free edge of the aneurysm through the border of the septal scar and pulled out through the adjacent right ventricular free wall. Associated procedures included 163 (coronary artery bypass grafts) and 49 antiarrhythmic treatments. Hospital and late mortalities were 6.2% and 10% respectively: 92% of the discharged patients were followed up. Actuarial survival rates were 89.9% and 83.7% at 1 and 5 years respectively. Clinical results showed functional improvement from a mean NYHA class 2.7 to 1.5 for dyspnea and from 2.1 to 1.1 for angina. The factors that seem to affect early and late prognosis are ejection fraction and preoperative congestive heart failure alone or associated with ventricular tachycardia. Ventricular septoplasty permits an optimal reconstruction of LV shape and function by excluding akinetic or dyskinetic septum. LV septoplasty can correct a postinfarction ventricular septal defect, if present, by excluding the involved portion of the septum.