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Reconstruction of the Left Anterior Descending Coronary Artery With an Internal Thoracic Artery Graft (pp.211-226) $100.00
Authors:  (Sergey Y. Boldyrev, Kirill O. Barbukhatty, Vladimir A. Porhanov, Department of Adult Cardiac Surgery, Regional Clinic Hospital #1 Kuban State Medical University, Krasnodar, Russian Federation)
Background. The diffusely diseased left anterior descending coronary artery (LAD) remains a challenge for interventional cardiologists and cardiac surgeons. In this study we assessed the surgical outcomes obtained from coronary artery reconstruction, with or without endarterectomy, for a diffusely diseased LAD.
Methods. Between 2003 and 2010, 165 patients with the diffusely diseased LAD underwent a coronary artery bypass grafting with shunt plasty (CABGSP) with a left internal thoracic artery (LITA) graft.
Results. The cohort consisted of 140 (85%) men and 25 (15%) women The mean age was 59,4 8 years. Coronary artery reconstruction was performed without endarterectomy in 129 patients (78%) and with endarterectomy in 36 patients (22%). The mean number of anastomoses per patient was 2,3 0.6. The mean length of the arteriotomy incision was 3.0 1.4 см (range, 2 to 8 cm). Mean cardiopulmonary bypass (CPB) time was 84 28 min (range, 29 to 171 minutes), and the mean aortic cross-clamp time was 58 21 minutes (range, 19 to 104 minutes). Overall survival, including all deaths, at 1, 7 and 10 years was 99%, 96%, and 90% respectively.
Conclusion.Coronary artery bypass grafting (CABG) associated with coronary artery reconstruction with plaque exclusion is possible when the LAD is diffusely and extensively diseased. These lesions were usually considered as not suitable for surgery. Atheromatous plaque exclusion should avoid growth and complications of excluded plaques. Limited endarterectomy with endarterectomised arterial wall exclusion decreases post-operative myofibro-intimal proliferation period and restenosis. An
acceptable perioperative mortality rate and morbidity, clinical results after 8 years and graft patency in our series are encouraging. 

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Reconstruction of the Left Anterior Descending Coronary Artery With an Internal Thoracic Artery Graft (pp.211-226)