Early postoperative outcome in diffusely diseased left anterior descending artery comparative study between endarterectomy and mammary arterial patch reconstruction

ABSTRACT

The problem of diffusely diseased LAD represents one of the surgical challenges with very few alternative solutions. Some my leave this diffusely diseased vessel without grafting and keep such patients on lifelong anticoagulation with the acceptance of some residual symptoms, others my do surgical grafting of this vessel using either extensive endarterectoy or creating a newly constructed LAD by the use of a long mammary artery graft patch. In this short prospective study we used both techniques in grafting the diffusely diseased LAD and we evaluated the early outcomes in the immediate post operative period [3 months]. This prospective shortterm study was done at Kasr Eleini teaching hospitals in the period between January 2006 and April 2009, 100 patients with severely and diffusely diseased LAD underwent bypass grafting. We used two techniques of LAD grafting. In group "A" [50 patients] we used the internal mammary artery for grafting after conventional endarterectomy [excision of the entire atheromata] while in the other group "B" [50 patients] we employed long mammary patch grafting of the LAD without coronary endarterectomy. In both groups selection of the technique was the surgeon's preference and there was no significant differences in the preoperative and operative criteria of patients. The preoperative data was not significantly different in both groups. The average length of endarterectomy in group A was 2.4 +/- 0.75 cm while the average length of mammary artery patch in group B was 3.2 +/- 0.8 cm. The duration of aortic cross clamp was 68.2 +/- 6.4 mm in group A and 78 +/- 8.5 mm in group B. there was higher postoperative mortality in group A [22%]. and only [8%] mortality in group B. ICU stay was 8.5 +/- 2.8 days in group A and 6.3 +/- 2.6 days in group B. postoperative myocardial infarction was higher in group A [32%] than that in group B [12%]. Also there was 4 cases in group A who needed additional saphenous vein grafting to the distal LAD, while no one needed additional LAD grafting in group B. postoperative bleeding was 540 +/- 86cm2 in group A and 830 +/- 116 cm2 in group B. long mammary arterial patch grafting of the LAD can be used as a surgical technique for grafting the diffusely diseased LAD. This technique provides better early postoperative outcome than that of LAD grafting after endarterectomy, however this study still needs longer evaluation of the graft patency in both groups. Pathological Q wave and positive cardiac biomarkers are predictors for worse prognosis among patients having myocardial infarction post-CABG