An increasing number of patients with diffuse, complex LAD lesions are referred for coronary artery bypass surgery. Adequate distal runoff can only be achieved by endarterectomy and reconstructive procedures.

Between September 1996 and September 1998, 89 patients underwent coronary bypass procedures combined with additional treatement to LAD. Sixty six patients were male and twentythree patients were female. Class III and IV anginal symptoms were present in 72%. IMA was used a conduit in 61 cases (68.5%). Surgical procedures were collected under 4 groups. In 37 patients long arteriomoty + saphenous vei patch+IMA bypass (Group Ia), in 14 patients endarterectomy in addition to procedures in Group 1b were done (Group Ib). In 11 patients 2 or more centimeter distal vein patch and proximal IMA reconstruction vein bypass (Group III) were performed. In 11 patients with multisegment lesions, multiple bypass by saphenousvein (Jumping) were done (Group IV). Three patients in group I and III died atearly postoperative period (Mortality 3.3%). Perioperative infarction was seen in three patients (3.3%). In group I, II and III. Inotropic support and IABP were necessiated for 2 cases in group I and for 3 cases in group III. In follow-up period ranging from 1-19 months (11±6.5 months), 77 patients were in class I or II. Control angiography was performed in two patients in group I and III. All the grafts were patent. Unfortunately, serious ventricular dysfunction was present in the patient in group III.

We belive that LAD must be reconstruted to provide runoff in diffuse LAD lesions. Reconstruction with saphenous vein patch can be done safely and enable to IMA bypass.

Keywords :