Objective(s): To report the early and mid-term results of surgical plasty of the left main coronary artery in 12 patients operated upon between 1993 and 1997.Methods: The anterior approach was used in all patients. Saphenous vein (n=4) or glutaraldehyde treated autologous pericardium (n=8) were used as patch material. Additional coronary artery bypass grafting was performed in 7 patients, the first 3 as a safety back up, and for coexisting stenosis of other coronary branches not revascularized by the plastic procedure in the remaining 4.Results: Pathologic specimens of the left main coronary artery in 5 revealed atheroma in 3 and myxomatous intimal thickening in 2. The left main coronary artery was widely patent angiographically in all patients prior to discharge. Six patients consented to angiographic restudy 5–40 months after the procedure and revealed excellent results in 5. One patient upon whom autologous pericardial patch had been used underwent percutaneous coronary angioplasty for restenosis of the left main coronary artery and a new lesion of the proximal left anterior descending branch 5 months after the operation. There were no late deaths nor other cardiac events. All patients were in CCS class 1 at their last follow-up.Conclusions: Surgical angioplasty of the left main coronary artery could be used to revascularize the left heart safely in patients with a discrete localized lesion of the left main coronary artery and is particularly useful in the face of unavailability of other conduits.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Effler DB, Sones FM, Favaloro R, Groves LK. Coronary endarterctomy with patch graft reconstruction: clinical experience with 34 cases. Ann Surg 1965; 162: 590–601.
Sabiston DC, Ebert PA, Friesinger GC, Ross RS, Sinclair-Smith B. Proximal endarterectomy: arterial reconstruction for coronary occlusion at aortic origin. Arch Surg 1965; 91: 58–64.
Favaloro RG, Effler DB, Groves LK, Sheldon WC, Shirey EK, Sones FM. Severe segmental obstruction of the left main coronary and its division. Surgical treatment by the saphenous vein graft technique. J Thorac Cardiovasc Surg 1970; 60: 469.
Sullivan J, Murphy D. Surgical repair of stenotic ostial lesions of the left main coronary artery. J Thorac Cardiovasc Surg 1989; 98: 33–6.
Hitchcock JF, Robles de Medina EO, Jambroes G. Angioplasty of the left main coronary artery for isolated left main coronary disease. J Thorac Cardiovasc Surg 1983; 85: 880–4.
DeMots H, Bonchek LI, Rosch J, Anderson RP, Starr A, Rahimtoola SH. Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am J Cardiol 1975; 36: 136–41.
Dion R, Verhelst R, Matta A, Rousseau M, Goenen M, Chalant C. Surgical angioplasty of the left main coronary artery. J Thorac Cardiovasc Surg 1990; 99: 241–50.
Ghosh PK. Coronary ostial reconstruction: technical issues. Ann Thorac Surg 1991; 51: 673–5.
Frater RWM, Jordan A. Syphilitic coronary ostia stenosis. Ann Thorac Surg 1968; 6: 463–7.
Cipriano PR, Silverman JF, Perlroth MG, Griepp RB, Wexler L. Coronary arterial narrowing in Takayasu’s aortitis. Am J Cardiol 1977; 39: 744–50.
Gaudiani VA, Siegel SB, McIntosh-Yellin NL. Left main coronary artery reconstruction after radiation therapy. Ann Thorac Surg 1994; 58: 567–9.
Middell AI, DeBoer A, Bermudez G. Postperfusion coronary ostial stenosis. J Thrac Cardiovasc Surg 1976; 72:80–5
Thompson R. Isolated coronary ostial stenosis in women. J Am Coll Cardiol 1986; 7: 997–1003.
Bailey CP, Lemmon WN. Survival after coronary endarterectomy. JAMA 1957; 164: 641–6.
Takaro T, Hultgren HN, Lipton MJ, Detre KM, for participants in the Study Group. The VA cooperative randomized study of surgery for coronary arterial occlusive disease, II: subgroup with significant left main lesions. Circulation. 1976; 54: III–107-117.
O’Keefe JH, Hartzler GO, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Ligon RW. Left main coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardiol. 1989; 65: 144–7.
Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR, et al: Contemporary percutaneous treatment of unprotected left main coronary stenoses — Initial results from a multicenter registry analysis 1994–1996. Circulation. 1997; 96: 3867–3872.
Park SJ, Park SW, Hong MK, Chong SS, Lee CW, Kim JJ, et al. Stenting of unprotected left main coronary artery stenoses: Immediate and late outcomes. J Am Coll Cardiol 1998; 31: 37–42.
About this article
Cite this article
Soga, Y., Okabayashi, H., Shimada, I. et al. Plastic surgical reconstruction of left main coronary artery. Jpn J Thorac Caridovasc Surg 47, 95–98 (1999). https://doi.org/10.1007/BF03217950
- surgical angioplasty
- left main coronary artery