Search

Background: Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents., Methods: We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch., Results: The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months., Conclusions: CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques., (© 2015 Wiley Periodicals, Inc.)

In this study we analyzed the surgical outcomes of reconstruction of the diffusely diseased left anterior descending artery (LAD) with saphenous vein patch, and by left internal thoracic artery (LITA) grafting on to the patch during on-pump coronary artery bypass surgery. Between 2009 and 2014, 21 patients (mean age 65.1 years) underwent vein patch angioplasty combined with left internal thoracic artery bypass. Five of them (24.8%) had a history of myocardial infarction, and 2 patients (9.5%) had unstable angina and 1 patient (4.8%) acute anteroseptal myocardial infarction. Twelve patients (54.0%) were Canadian Cardiovascular Society class III or IV, and 10 patients (48.0%) were New York Heart Association class III or IV. The mean number of distal anastomoses per patient was 3.24±0.62. The mean length of vein patch was 4.14±0.82 cm. The 30-day mortality rate was 4.8% (n=1). There were 3 late cardiac-related deaths observed at postoperaticve 2., 11., and 40. month The actual survival was 90.0% at 2, and 81.0% at five years. Follow-up angiogram (15 patients, 71.4%) revealed patent LITA graft in 93.3% of the patients. Long segmental LAD reconstruction with autologous saphenous vein patch without endarterectomy, provides alternative approach with acceptable long-term results to the patients who have diffusely diseased coronary arteries. [ABSTRACT FROM AUTHOR]