Cardiovascular Journal of Africa: Vol 30 No 1 (January/February 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019 AFRICA 57
Long-segment patchplasty of diffuse left anterior
descending artery disease on the beating heart
Erhan Kaya, Omer Isik
Abstract
Objective: The rate of patients with diffuse left anterior
descending artery (LAD) disease being referred for surgery
has increased as a result of advances in endovascular tech-
niques. In surgery of diffuse or multisegment LAD disease,
surgical procedures with or without endarterectomy can
be performed. In this article, we report our results of long-
segment onlay patchplasty of the LAD with a left internal
thoracic artery (LITA) graft without endarterectomy, on the
beating heart, in patients with multisegment LAD disease.
Methods: We retrospectively analysed patients who under-
went coronary artery bypass grafting surgery in our hospital
between 1 January 2015 and 31 July 2017. We included LITA
onlay patchplasty patients with multisegment LAD disease
who had been operated on the beating heart. We excluded
patients who underwent coronary endarterectomy and were
operated on under cardiopulmonary bypass.
Results: In this period, 54 patients with multisegment LAD
disease were treated with LITA patchplasty on the beating
heart. The mean length of the arteriotomy was 42.8 ± 13.3
mm (25–75 mm). There were two postoperative myocardial
infarctions (3.7%) and three deaths (5.5%). In the remain-
ing patients, there was no haemodynamic instability that
needed long-term (> 24 hour) inotropic support. Patients were
discharged from hospital on postoperative 9.3 ± 7.1 days with
dual antiplatalet therapy.
Conclusion: Bypass grafting of the LAD with long-segment
LITA onlay patchplasty can safely be performed in patients
with multisegment LAD disease, with acceptable early-term
results. In this procedure, proximal and distal segments of
the diseased LAD are revascularised with LITA grafts, which
may improve long-term survival and quality of life.
Keywords: coronary artery disease, endarterectomy, patchplasty
Submitted 6/8/18, accepted 31/10/18
Published online 7/1/19
Cardiovasc J Afr 2019; 30: 57–60
DOI: 10.5830/CVJA-2018-062
Percutaneous intervention is currently preferred in segmental
coronary artery lesions as a result of advances in angiographic
techniques. Recently, the rate of patients undergoing surgery for
diffuse or multisegment disease in the left anterior descending
(LAD) artery has increased. In long-segment LAD lesions,
incomplete revascularisation is the most important factor that
affects long-term mortality and morbidity rates.1
In surgical tratment of diffuse/multisegment LAD
disease, endarterectomy, long-segment patchplasty without
endarterectomy, sequential jumping bypass and bypass grafting
with two different grafts can be performed.2 In diffuse LAD
lesions, plaque exclusion with the left internal thoracic artery
(LITA) is a safe method and has similar results to conventional
coronary artery bypass graft (CABG) surgery with no diffuse
lesions.1 In this article, we present our LITA onlay patchplasty
experience on the beating heart in multisegment LAD lesions.
Methods
We retrospectively analysed patients who had undergone CABG
surgery at the Private Pendik Regional Hospital between 1
January 2015 and 31 July 2017. We included patients with
multisegment LAD disease treated with LITA onlay patchplasty
on the beating heart. We excluded patients who underwent LAD
endarterectomy or distal bypass with other grafts and were
operated under cardiopulmonary bypass. Demographic and
clinical information were collected from a review of the medical
records.
All procedures were performed under general anaesthesia
with off-pump technique and a median sternotomy. During
the operation, distal anastomosis of the right coronary artery
(RCA) and circumflex artery was performed with the standard
procedure. Arteriotomy of the LAD was started distal of the first
proximal lesion and extended to the disease-free distal portion.
Arteriotomy of the LITA was done according to arteriotomy
of the LAD. Then the LITA–LAD anastomosis was performed
to reconstruct the LAD with an onlay LITA graft (Fig. 1). The
operation was completed after haemostatic control.
Statistical evaluation was performed using Microsoft Excel
software. Continuous variables are reported appropriately as
mean (± SD) and categorical variables are reported as frequency.
Results
In this period, 54 patients with multisegment LAD disease were
treated with LITA onlay patchplasty. Patients’ characteristics
and demographic findings are shown in Table 1. Of the patients,
59.3% with acute coronary syndrome underwent surgery. All
patients were operated on the beating heart and there was no
conversion to cardiopulmonary bypass. A mean of 2.9 ± 0.7
coronary artery bypasses were performed and the mean length
of LAD arteriotomy was 42.8 ± 13.3 mm (25–75 mm).
In the postoperative period, there were two myocardial
infarctions (MI) (3.7%) and three deaths (5.5%). One patient
was re-operated due to low cardiac output and postoperative
MI. In the re-operation, the grafts were patent and there was no
Department of Cardiovascular Surgery, Private Pendik
Regional Hospital, Istanbul, Turkey
Erhan Kaya, MD,
Omer Isik, MD