Surgical Coronary Ostial Plasty
Critical stenosis of the right coronary ostium (RCO) and the left main coronary artery (LMCA) is usually treated by conventional bypass surgery. However, this approach consumes an appreciable length of conduit, leads to occlusion of the RCO and LMCA, and restores only a retrograde perfusion of a rather extensive myocardial area. Since June 1985, we have performed 18 LMCA and 3 RCO patch plasties in 20 patients, aged 38 to 72 years. The RCO was divided longitudinally across the stenosis, and the incision was extended for 2 cm onto the aortic wall; a venous or pericardial (one case) inlay patch was used to close the defect, so as to obtain a funnel-shaped RCO as a final result. The LMCA was approached either posteriorly via a curved aortotomy (12 cases) or anteriorly (6 cases) after retraction and, in a few cases, partial or complete division of the main pulmonary artery. A similar incision and inlay patch technique as for RCO stensosis was used. In two patients, a posterior LMCA plasty failed and a conventional double bypass graft was needed. One of these patients underwent a successful repeat-patch plasty 8 months later using a transpulmonary anterior approach. There was one perioperative myocardial infarction, but no mortality. Thirteen patients underwent a 6-month postoperative angiographic control, with an excellent result in 12 cases; a significant LMCA restenosis was successfully treated by percutaneous coronary angioplasty in one asymptomatic patient who had concomitantly received a sequential mammary graft. The other four patients are asymptomatic. The direct surgical approach to RCO and LMCA critical stenosis is a valuable alternative treatment of this condition.
KeywordsLeave Anterior Descend Right Coronary Artery Aortic Wall Left Main Coronary Artery Main Coronary Artery Disease
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