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CABG Should Be the First Option for Left Main Disease: A Cardiac Surgeon’s Perspective

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Left Main Coronary Revascularization

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Abstract

The treatment of obstructive coronary artery disease involving the left main is still a challenge today, due to the need for urgent revascularization because of the high ischemic risk of these patients.

The anatomical complexity of these lesions and the frequent concomitance of multi-vessel disease make surgical revascularization the treatment of choice and current guidelines still support coronary artery bypass as the gold standard approach for the treatment of left main stenosis.

However, the development of new endovascular techniques and the improvement of transcatheter materials have rekindled the debate on the chance of transcatheter treatment approach for this pathology.

In this chapter, we report and discuss the results of the main clinical trials on this topic and we analyze the variables that should be considered by surgeons and interventional cardiologists to choose the best revascularization strategy for each patient.

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Abbreviations

ACS:

Acute coronary syndrome

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

ISR:

Intra-stent restenosis

LAD:

Left anterior descending

LM:

Left main

MACCE:

Major adverse cardiac and cerebrovascular event

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

SSII:

Syntax score II

STS:

Society of thoracic surgery

UDMI:

Universal definition of myocardial infarction

ULM:

Unprotected left main

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Authors and Affiliations

  1. Cardiac Surgery Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

    Guido Gelpi, Claudia Romagnoni & Irene Binaco

  2. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy

    Guido Gelpi

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  1. Guido Gelpi
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  2. Claudia Romagnoni
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  3. Irene Binaco
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Correspondence to Guido Gelpi .

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Editors and Affiliations

  1. Fondazione Ricerca e Innovazione Cardiovascolare, MILANO, Milano, Italy

    Bernardo Cortese

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Gelpi, G., Romagnoni, C., Binaco, I. (2022). CABG Should Be the First Option for Left Main Disease: A Cardiac Surgeon’s Perspective. In: Cortese, B. (eds) Left Main Coronary Revascularization . Springer, Cham. https://doi.org/10.1007/978-3-031-05265-1_5

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  • DOI: https://doi.org/10.1007/978-3-031-05265-1_5

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-05265-1

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