Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: Long-term angiographic results of 2 different revascularization strategies

Mario Gaudino, Massimo Massetti, Piero Farina, Claude Hanet, Pierre Yves Etienne, Andrea Mazza, David Glineur

Résultats de recherche: Contribution à un journal/une revueArticleRevue par des pairs

Résumé

Objective To compare 2 different surgical approaches to treatment of patients with isolated predivisional stenosis of the left main coronary artery (IOSLM) and to evaluate the effect of chronic competitive flow from a patent arterial or venous graft to the circumflex system on the long-term patency of internal thoracic artery (ITA) to left anterior descending grafts.

Conclusions In patients with IOSLM, long-term ITA to left anterior descending artery patency is not jeopardized by chronic flow competition from a concomitant arterial or venous graft to the circumflex system. Notably, the addition of a second ITA graft or of a SV to the first ITA does not lead to differences in long-term angiographic patency. Our results minimize the role of flow competition in this setting and should be kept in mind when choosing the appropriate graft configuration.

Methods Thirty-two patients with IOSLM were treated at our institutions during a 9-year period: 14 patients received double ITA grafts, whereas 18 underwent ITA graft plus saphenous vein (SV) bypass. All patients were reviewed clinically and angiographically at long-term follow-up.

Results No patient died during hospitalization. At a mean follow-up of 96 ± 9 months 7 patients had died (6 from noncardiac causes) and 5 had experienced angina/ischemia recurrence, without differences between the 2 revascularization strategies. At control reangiography all ITA and SV grafts were found to be fully patent, without evidence of caliber reduction or string sign in the ITA.

langue originaleAnglais
Pages (de - à)1856-1859
Nombre de pages4
journalJournal of Thoracic and Cardiovascular Surgery
Volume148
Numéro de publication5
Les DOIs
Etat de la publicationPublié - 1 nov. 2014
Modification externeOui

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