Left main coronary disease treated by direct surgical angioplasty: long-term results.

Background: Left main coronary artery (LMCA) disease is currently treated by coronary artery bypass grafting or, more recently, by percutaneous coronary intervention. Occasionally, direct surgical patch angioplasty of the LMCA can be proposed as an alternative treatment. The aim of this study was to analyze, on a long-term basis, the safety and efficacy of this technique.

Methods: This retrospective analysis was obtained from clinical data between April 1995 and December 2008: 91 consecutive patients (67 men, 24 women; mean age: 58+/-10 years) underwent surgical angioplasty of the LMCA with an autologous pericardial patch. Among them, 80 (87.9%) presented an isolated LMCA disease. Mean logistic European system for cardiac operative risk evaluation of this series was 3.9+/-2.9. Concomitant surgical procedures included coronary artery bypass grafting (n=11; 12%), valve procedure (n=5; 5.5%), and carotid endarterectomy (n=1; 1.1%). We analyzed the early and late mortality, major adverse cardiac or cerebral event rate, and repeat revascularization rate.

Results: The mean follow-up was 7.22+/-3.60 years (maximum 13.8 years, minimum 180 days). Perioperative mortality was 1.1%. Five and ten-year global survival was 95+/-4.5% and 80+/-8.3%, respectively. Major adverse cardiac or cerebral event rates at five and ten years were, respectively, 21+/-8.4% and 31+/-9.6%. First repeat postoperative revascularization rate was 12+/-6.8% at five and 17+/-7.8% at ten years (n=10 patients). Among them, repeat target lesion revascularization concerned four patients.

Conclusions: Similar to other series, our study shows satisfactory long-term outcomes with the surgical patch-plasty of LMCA. This technique can be proposed as an efficient and safe alternative to selected patients, particularly in case of isolated LMCA disease without extended calcification.