In patients with diffuse left anterior descending (LAD) coronary artery atherosclerosis disease necessitating extensive endarterectomy during coronary bypass operation is known to have a good benefit to these kind of patients but with a very high risk. We present at this paper a study of patients with diffuse LAD coronary artery atherosclerosis disease whom undergoing coronary bypass grafting including methods of bypass, and early postoperative coronary angiography results.

Methods:

During January 1999 and December 1999, 729 patients were admitted to our hospital for coronary bypass grafting, twelve of them had LAD endarterectomy with left internal mammary artery (LIMA) anastomsed directly or using saphenous vein patch angioplasty. There were 10 men and 2 women with a mean age of 56.42 ± 7.87 years. Mean left ventricular performance score was 9.83 ± 2.82, end mean and-diastolic pressure was 17.42 ± 5.69. mmHg Each patient had 2.17 ± 0.85 grafts end 4 patients (33%) required multiple endarterectomies. Using cardiopulmonary bypass we performed blind endarterectomy to LAD and using LIMA directly to bypass the LAD for 7 patients and with saphenous vein patch in 5 patients. Postoperative one patient (8.3%) required intraaortic balloon and two patients (16.6%) required inotropic support. There was no perioperative infarction.

Results:

Postoperatively one patient (8.3%) developed atrial fibrillation and two patients (16.6%) ventricular arrhythmia whom were converted to normal sinus rhythm using amiodarone. There was no early or late deaths at a mean follow-up of 7.08 ± 2.97 months. All the patients were free of angina after operation. Control coronary angiography was performed to all the patients after 5.17 ± 2.33 months and was demonstrated 100% anastomotic patency, with good distal run-off in all the patients. The anterior segmental wall motion was improved in all the patients (p < 0.05).

Conclusions:

During coronary bypass grafting to patients with diffuse atherosclerosis disease an extensive LAD endarterectomy and use of a suitable graft as IMA can provide a good distal run-off which can improve the patients status.