Dealing With Diffusely Diseased Left Anterior Descending Coronary Artery Mansoura University Hospital Experience

Abstract

Background: Nowadays, due to the rapid advances in PCI, a large number of patients referred for CABG have diffusely diseased LAD. This makes surgery difficult as conventional anastomosis can’t be used and reconstructive procedures are needed to achieve complete revascularization. We aimed to demonstrate different surgical techniques to deal with diffusely diseased LAD and when to choose each technique.

Methods: Sixty patients who had diffusely diseased LAD and underwent CABG with reconstructive procedures for the LAD in the Cardiothoracic Surgery Department, Mansoura University Hospital between January 2018 and September 2022 were studied. Post-operative assessment was done including post-operative IABP usage, post-operative MI, post-operative arrhythmia, re-exploration, CVA, AKI, [1]mortality in ICU and ECHO and clinical follow up before discharge and three months after surgery.

Results: LIMA on-lay patch was the standard technique used. GSV used for reconstructing the LAD when the LIMA was short or the anastomosis was very long followed by LIMA anastomosis to GSV patch. 32 patients had mammary on-lay patch while 14 patients had venous patch. Endarterectomy was done in 13 patients. 5 patients had open endarterectomy with mammary patch, 6 patients had open endarterectomy with venous patch, 2 patients had closed endarterectomy and T-graft was done in 1 patient. There was no post-operative IABP usage, MI, re-exploration, CVA or AKI. Post-operative arrhythmia occurred in 17 patients. Two patients died in the ICU due to chest infection. Patients were satisfied post-operative with improvement of symptoms and ECHO showed satisfactory results.

Conclusion: Reconstruction of the diffusely diseased LAD can be done using different surgical reconstructive techniques with reasonable CPB and cross clamp time and with very good results.