Procedural results and outcomes after extensive stent coverage with drug-eluting stent implantation in single coronary lesions

Off-pump bypass of the left anterior descending coronary artery: 23- to 34-year follow-up

OBJECTIVE

We sought to develop a baseline for long-term survival of patients after off-pump bypass of the left anterior descending coronary artery with the heart beating.

METHODS

We reviewed results for 241 consecutive patients with significant obstruction of the left anterior descending coronary artery who underwent surgery between November 1969 and the end of 1980. The off-pump operative technique involved elevating and stabilizing a segment of the distal left anterior descending coronary artery with 4 traction sutures. Starting in 1973, an internal thoracic artery became the graft of choice, so that a total of 171 patients received an internal thoracic artery bypass graft, and 70 patients received a saphenous vein graft.

RESULTS

The median survival of patients with internal thoracic artery grafts was 23.7 years versus 17.9 years for patients with venous grafts (P < .02). Early patency of arterial grafts was 95%, and late patency was 90%. There were 2 (0.8%) operative deaths. Seventy of the 74 patients still alive in 2003 were interviewed by telephone, and 40 (57%) did not require additional invasive treatment, which is consistent with our finding that more than 50% of our patients after bypass of the left anterior descending coronary remained stable without obstruction of the right or circumflex arteries. However, atherosclerosis progressed in 30 (43%) of the survivors, who underwent reinterventions.

CONCLUSIONS

Off-pump bypass of the left anterior descending coronary artery with an internal thoracic artery can be done on a beating heart safely and results in median survival of patients for more than 23 years.

Anomalous origin of the right coronary artery: Right internal thoracic artery to right coronary artery bypass is not the answer

OBJECTIVE

Anomalous origin of the right coronary artery from the opposite sinus of Valsalva can be a lethal congenital anomaly. Right internal thoracic artery grafting to the right coronary artery is prone to fail in this circumstance. We sought to describe alternative surgical techniques.

METHODS

Retrospective analysis identified 5 adult and pediatric patients in our database. We reviewed the surgical techniques used to repair this anomaly. On the basis of our experience, we describe our management technique.

RESULTS

There were no operative deaths, and postoperative computed tomographic scans demonstrated widely patent repairs in all patients. Two patients with previous right internal thoracic artery to right coronary artery grafts presented with occlusion of the right internal thoracic artery. Short-term follow-up demonstrated continued patency.

CONCLUSION

Right internal thoracic artery grafting fails in this circumstance, and alternative surgical options provide a good outcome.