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Vein patch angioplasty combined with left internal thoracic artery bypass to left anterior descending artery in patients having diffuse complex atherosclerotic lesions [Medeniyet Med J]
Medeniyet Med J. 2016; 31(2): 82-87 | DOI: 10.5222/MMJ.2016.082  

Vein patch angioplasty combined with left internal thoracic artery bypass to left anterior descending artery in patients having diffuse complex atherosclerotic lesions

Tolga Demir
Kolan International Hospital, Department Of Cardiovascular Surgery

In this study we analyzed the surgical outcomes of reconstruction of the diffusely diseased left anterior descending artery (LAD) with saphenous vein patch, completed by left internal thoracic artery (LITA) grafting on to the patch during on-pump coronary artery bypass surgery.
Between 2009 and 2014, 21 patients (mean age 65.1 years) underwent vein patch angioplasty combined with left internal thoracic artery bypass. Five of them (24.8%) had a history of old myocardial infarction, and 2 patients (9.5%) had unstable angina and 1 patient (4.8%) had acute anteroseptal myocardial infarction. Twelve patients (54.0%) were Canadian Cardiovascular Society class III or IV, and 10 patients (48.0%) were New York Heart Association class III or IV. The average of distal anastomoses per patient was 3.24 ± 0.62. The mean lenght of vein patch was 4.14 ± 0.82 cm.
The 30-day mortality rate was 4.8% (n=1). There were 3 late cardiac-related deaths at the 2 month, 11 month and 40 month follow-up, respectively. The actual survival was 90.0% at 2 years and 81.0% at five years. Follow-up angiogram (15 patients, 71.4%) revealed patent LITA graft in %93.3 of the patients.
Long segmental LAD reconstruction with autologous saphenous vein patch without endarterectomy, provides alternative approach to the patients who have diffusely diseased coronary arteries, with acceptable long-term results.

Keywords: Coronary artery surgery, left anterior descending artery, vein patch angioplasty


Yaygın kompleks aterosklerotik lezyonu olan hastalarda sol ön inen arterin sol internal torasik arter bypass ile kombine edilen venöz patch anjioplastisi

Tolga Demir
Kolan International Hospital, Kalp Damar Cerrahisi Kliniği

Bu çalışmada, yaygın hasta sol ön inen arterin, koroner arter bypass cerrahisi sırasında, safen ven patch ile rekonstrüksiyonu ve sol internal torasik arterin patch ile anastomuzunun cerrahi sonuçlarını analiz ettik.
2009 ve 2014 yılları arasında 21 hastaya (ortalama yaş 65.1 yıl) sol internal torasik arter bypass ile kombine edilen venöz patch anjioplastisi yöntemi uygulandı. Hastaların 5 inde (%24.8) geçirilmiş miyokard enfarktüsü hikayesi vardı. İki hastada (%9,5) kararsız angina ve 1 hastada (%4.8) akut anteroseptal miyokard enfarktüsü vardı. On iki hasta (%54.0) Kanada Kardiyovasküler Cemiyeti sınıf III veya IV ve 10 hasta (%48.0) New York Kalp Birliği sınıf III veya IV idi. Hasta başına yapılan ortalama distal anastomoz sayısı 3.24 ± 0.62 idi. Ortalama ven patch uzunluğu 4.14 ± 0.82 cm idi.
Otuz günlük mortalite oranı %4.8 (n=1) idi. Takiplerde, 2 si kardiyak kökenli olmak üzere sırasıyla 2 inci ay, 11 inci ay ve 40 ıncı aylarda toplam 3 geç dönem ölüm oldu. Gerçek yaşam oranı 2 yılda %90.0 ve 5 yılda %81 idi. Kontrol anjiyografisi (15 hastada, %71.4) hastaların %93.3 ünde çalışan sol internal torasik arter greftini ortaya koydu.
Sol ön inen arterin endarterektomi yapılmadan, otolog safen ven patch ile uzun segment rekonstrüksiyonu, yaygın hasta koroner arteri olan hastalarda kabul edilebilir uzun dönem sonuçlarıyla, alternatif bir yaklaşım sağlar.

Anahtar Kelimeler: Koroner arter cerrahisi, sol ön inen arter, venöz patch ajioplasti


Tolga Demir. Vein patch angioplasty combined with left internal thoracic artery bypass to left anterior descending artery in patients having diffuse complex atherosclerotic lesions. Medeniyet Med J. 2016; 31(2): 82-87

Corresponding Author: Tolga Demir, Türkiye


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