Dual left anterior descending artery - a clinical entity in search of an identity: A novel classification.

A dual left anterior descending artery (LAD) is not an uncommon anomaly of the coronary arterial system. The earlier classifications by various authors lacked standardization and uniformity and are too complex for clinical usage. Therefore, a new classification in the form of coding system is proposed to facilitate the identification and reporting of the anomaly by the cardiologists to maintain uniformity in reporting, which aids in adequate planning of the revascularization strategies in patients with symptomatic coronary artery disease involving the dual LAD system.

Surgical revascularization strategies of CAD involving dual left anterior descending artery.

Dual left anterior descending artery (LAD) is not an uncommon coronary artery anomaly. Preoperative identification of this anomaly in patients with coronary artery disease is important to develop strategies to ensure complete revascularization of the LAD territory. From April 1996 through February 2022, more than 16,500 patients underwent isolated coronary artery bypass surgery (CABG) by our team. Retrospective review of the angiographic and operative records of these patients revealed 85 cases with stenosis of the dual LAD system. The incidence of dual LAD in patients undergoing CABG is 0.51%. Among the 85 patients, 59 (69.4%) had stenosis of both long and short LADs, whereas the remaining 26 (30.5%) had stenosis of either of the LADs. Among the 59 patients who had stenosis of both the LADs, 26 (44.1%) received a left internal thoracic artery (LITA) sequential graft to bypass both the LADs and two received a LITA-LITA baby-Y graft. And in 31 (52.5%) patients, the longer LAD was revascularized with LITA and the other LAD with saphenous vein graft.

Impact of occult renal disease on the outcomes of off-pump and on-pump coronary artery bypass grafting.

PURPOSE: Occult renal disease (ORD) is a clinical condition in which glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m2, while serum creatinine is ≤ 1.3 mg/dl. The aim of the study was to compare the incidence of postoperative stage I acute kidney injury (AKI) according to Acute Kidney Injury Network (AKIN) classification in patients with ORD undergoing either off-pump or on-pump coronary artery bypass grafting. METHODS: A single center prospective randomized study was conducted from March 2011 through January 2014. A total of 120 coronary artery disease (CAD) patients with ORD undergoing coronary artery bypass grafting (CABG) were randomized to either off-pump (group1, n = 62) or on-pump (group2, n = 58) CABG in 1:1 ratio by computer-generated random number table. The GFR and serum creatinine levels were measured preoperatively and postoperatively on day 1 and day 5. The primary outcome (postoperative AKI (stage I)) and secondary outcomes (AKI (stage III) requiring renal replacement therapy (RRT) death, myocardial infarction (MI), cerebrovascular accident, atrial fibrillation (AF), and re-exploration for bleeding) at 30 days were analyzed between the groups. RESULTS: There is no significant difference in baseline characteristics of patients between off-pump and on-pump group. The incidence of postoperative AKI (stage I) was similar between on-pump (20.69%) and off-pump (16.13%) groups (p = 0.51). There was no significant difference in mortality (p = 0.33), postoperative MI (p = 0.34), cerebrovascular accident (p = 1.00), re-exploration (p = 0.96), and AF (p = 0.50). The number of patients of stage III AKI requiring RRT was higher in the off-pump group (3 patients, 4.8%) and none in the on-pump group (p = 0.08). CONCLUSIONS: This study demonstrated that on-pump CABG is associated with significantly lower GFR and significantly higher serum creatinine on postoperative day 1 which return to baseline by postoperative day 5. In patients with ORD undergoing CABG, the incidence of postoperative AKI and major adverse cardiac and cerebrovascular events were similar between off-pump or on-pump CABG patients.