Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery.

Background: We performed long segmental reconstruction of the left anterior descending coronary artery (LAD) using the left internal thoracic artery (LITA) in patients with diffusely diseased coronary arteries. Our study investigated short- and long-term outcomes and angiographic results after complete revascularization using this technique.
Methods: Between March 1995 and March 2001, 112 patients (mean age 63 years) underwent long segmental LAD reconstruction (≥2 cm) with or without endarterectomy using the LITA. Of these, 68 patients (61%) had a history of old myocardial infarction, 44 (39%) had undergone prior percutaneous coronary intervention, 39 (35%) had unstable angina, and 11 (10%) required preoperative intraaortic balloon pumping.
Results: The majority of patients (96%) underwent operation under cardiac arrest. All patients underwent a complete revascularization with long segmental LAD reconstruction using the LITA. The average length of arteriotomy was 3.7 cm, and 43 patients (38%) underwent extensive (≥4 cm) LAD reconstruction. Endarterectomy was performed in 37 patients (33%). The early mortality rate was 1.8% (2 of 112). Perioperative myocardial infarction in the LAD territory was 5.4%. The 5- and 10-year survival rates were 91% and 74%, respectively. Freedom from major adverse cardiac events at 10 years was 77%. Early angiography (n = 99) showed a 99% excellent patency rate of the LITA. Midterm (n = 61) and long-term (n = 23) follow-up angiography both showed 100% excellent patency rate of the LITA.
Conclusions: Long segmental LAD reconstruction with or without endarterectomy using the LITA provided excellent long-term outcomes and acceptable early operative results, even in patients with diffusely diseased coronary arteries.
(Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)