Reconstruction of a Diffusely Diseased Left Anterior Descending Coronary Artery with Left Internal Thoracic Artery Patch: One year follow up

Khaled  Mohamed Abdelaal; Ayman  Mohammad Abdelghaffar; Sharaf E.D. Mahmoud; Mohamed Eid; Abdelhady  Ahmad Helmy; Mohamed Abdel-Bary

doi:10.35810/ects.v4i2.209

Khaled Abdelaal Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Ayman Abdelghaffar Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Sharaf Mahmoud Department of Internal Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
Mohamed Eid Department of Internal Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
Abdelhady Ahmad Helmy Department of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, Egypt
Mohamed Abdel-Bary Department of Cardiothoracic Surgery, Qena Faculty of Medicine, South Valley University, Egypt http://orcid.org/0000-0002-7734-9089

DOI: https://doi.org/10.35810/ects.v4i2.209

Keywords: Left anterior descending coronary artery reconstruction, Extensive coronary artery disease, Endarterectomy, Left internal thoracic artery patch

Abstract

Background: Management of patients with extensive coronary artery disease (CAD) is challenging. This study presents the results of extensive reconstruction of the left anterior descending (LAD) coronary artery using the left internal thoracic artery (LITA) patch in patients with extensive LAD disease.

Methods: This study was conducted between January 2017 and April 2020 and included 86 patients. Males presented 88% (n=76), and the mean age was 57.8±7.31 years. Patients underwent long (2- 4 cm, n= 51) or extensive (≥4 cm, n=. 35) segment reconstruction of the LAD using LITA graft. Associated comorbidities were diabetes mellitus (n= 68, 79%), hypertension (n=, 60, 69%), and chronic kidney disease (n= 5, 5.8%).

Results: The mean cardiopulmonary bypass and aortic cross-clamp times were 107 ±21.24 and 68±12.8 min, respectively. ICU stay ranged from 1 to 15 days and hospital stay from 6 to 30 days. Seven patients (8%) needed IABP, 3 (3.5%) had low cardiac output, 10 (11.5%) had pulmonary complications, 5 (5.8%) had mediastinitis, 7 (8%) had a stroke, and 5 (5.8%) had acute kidney injury. Mortality occurred in seven patients (8%), 4 (4.6%) had hospital mortality, and 3 (3.5%) had late mortality. During the 1-year follow-up, 7 (8%) patients had recurrent anginal pain. CT angiography showed patent LITA to LAD in 6 patients.

Conclusion: Extensive LITA patch reconstruction of the diffuse LAD disease could be a safe procedure with accepted early clinical outcomes.