Left internal mammary on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased left anterior descending artery

Moataz E Rezk; Mahmoud Gamal; Ibrahim Kasb; Yousry Shaheen; Mahmoud El Shafiey

doi:10.35810/ects.v1i1.255

Moataz E Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mahmoud Gamal Department of Cardiac Surgery, Nasser Institute, Cairo, Egypt
Ibrahim Kasb Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Yousry Shaheen Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mahmoud El Shafiey Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

DOI: https://doi.org/10.35810/ects.v1i1.255

Keywords: Coronary Artery Bypasses Grafting, Left Anterior Descending Artery, Left Internal Mammary Artery, Saphenous Vein Graft, Venous patch

Abstract

Background: Several operative techniques were described to reconstruct the diffusely diseased left anterior descending coronary artery (LAD). The superiority of the left internal mammary artery (LIMA) vs. the saphenous vein patch is controversial in LAD reconstruction. Thus, this study compared LIMA on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased LAD artery.

Methods: This study was conducted between June 2020 and May 2022 including 60 patients with a diffusely diseased LAD. LIMA patch was used in 30 patients (Group I) and saphenous vein patch in 30 patients (Group II) without endarterectomy. Males presented 85%; the mean age was 56.68 ± 6.44 years. The mean patch length in the LIMA group was 4.48±0.87 cm and 4.60± 0.93 cm in the saphenous vein group.

Results: The mean aortic cross-clamp and cardiopulmonary bypass times were 66.80± 19.93 and 108.00± 25.74 minutes in the LIMA group and 84.40± 30.65 and 132.53± 45.41 minutes in the venous Group (P= 0.011 and 0.013, respectively). The mean intensive care unit stay was 50.40 ± 38.65 hours in Group I and 92.00± 51.62 hours in Group II (P˂ 0.001). Four patients (13.3%) needed an intra-aortic balloon pump (IABP) in Group I, and 11 patients (36.7%) in Group II (P= 0.037). Postoperative low cardiac output occurred in 13.3% of Group I and 53.3% in Group II (P= 0.001). Postoperative atrial fibrillation occurred in 13.3% of Group I, while in Group II was 33.3% (P= 0.067). The renal complications were 3.3% in Group I and 16.7% in Group II (P= 0.085). Two patients (6.7%) were complicated with bleeding in Group I, and nine (30.0%) in Group II (P= 0.02). The postoperative ejection fraction was 58.17± 5.25% in Group I and 53.3± 5.23% in Group II (P= 0.001). On the first postoperative day, the creatine kinase-myoglobin binding level was 61.73± 30.19 IU/L in Group I and 92.63± 45.88 IU/L in Group II (P= 0.004). Hospital mortality occurred in one patient (3.3%) in Group I and two in Group II (6.7%) (P˃ 0.99).

Conclusion: LAD reconstruction using the LIMA patch could have better early outcomes than the saphenous vein patch.