Follow-Up of Patients Operated on With Arterial Patch Angioplasty of the Left Main Coronary Artery

Background Surgical angioplasty of the left main coronary artery (LMCA) can be performed with good results in selected patients. It restores the native antegrade blood flow in the LMCA and does not leave the patient with a graft-dependent retrograde perfusion. By using a proximal segment of the right internal mammary artery as patch material, we assumed that this would minimize the risk of restenosis of the LMCA. We here review our experience and results. Methods Forty-three patients were operated on with LMCA angioplasty from 1997 to 2003. Follow-up at a mean of 45 months (range, 7 to 79) included a stress test, echocardiography, and angiography with intravascular ultrasound (IVUS) of the LMCA. Results There were three late deaths, none related to failure of the angioplasty. All patients included in the follow-up had preserved preoperative left ventricular function, and there was no aortic incompetence. The angioplasties investigated were patent, and no signs of restenosis or dilatation could be observed. The dimensions of the LMCA after angioplasty was in diameter 4.8 mm (3.35 to 6.75 mm) and 5.6 mm (4 to 7.6 mm), and in area 18.9 mm2 (12.3 to 31.9 mm2) and 24.8 mm2 (14.5 to 37 mm2) in the distal and proximal parts, respectively. Conclusions Surgical angioplasty of the left main coronary artery using a proximal segment of the right internal mammary artery as an onlay patch is safe, with good long-term results.