Surgical angioplasty of the left main coronary artery and/or proximal segment of the right coronary artery: An 11-years experience

Objectives: There are two surgical options for the management of isolated stenosis of left main stem or right coronary ostium: either surgical angioplasty of the ostial lesion or CABG. There are controversial opinions about the expedience of the surgical angioplasty. Results must be evaluated as an alternative to interventional procedures.

Methods: From January 1995 through August 2006, 24 patients underwent a surgical angioplasty for coronary osteal stenosis. There were 12 males and 12 females. Mean age was 64 years (48–82 years). The left or right coronary ostium was approached through a curved aortotomy. Reconstruction was performed using fresh autologous venous patch (n=22) or a tailored Dacron patch (n=2). All procedures were successfully performed except in one patient whereby we were obliged to bypass the left anterior descending and the circumflex arteries with venous grafts due to persistent rhythm disturbances.

Results: There were no hospital deaths. The follow up period ranged from 1 month up to 133 months with an average of 41 months. Patency of the coronary system was assessed by angiography or multi-slice CT scan and/or TEE. One patient died 6 years postoperatively due to heart failure. One of the patients required a reoperation 23 months after the initial operation after many trials of PTCA and stenting of the left coronary system.

Conclusions: Surgical angioplasty is an alternative safe option for treating ostial coronary stenoses providing excellent long term results. This finding is important regarding interventional attempts with PCI and stenting of ostial stenoses.