Vein patch angioplasty combined with left internal thoracic artery bypass to left anterior descending artery in patients having diffuse complex atherosclerotic lesions.

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]