In:
The Heart Surgery Forum, Forum Multimedia Publishing LLC, Vol. 17, No. 1 ( 2014-03-14), p. 47-
Abstract:
〈 p 〉 〈 b 〉 Objective: 〈 /b 〉 We evaluated the efficacy and safety of dual protection therapy with staged coronary artery bypass grafting (CABG) and bare-metal stenting (BMS) in patients with left main coronary artery (LMCA) disease. 〈 /p 〉 〈 p 〉 〈 b 〉 Background: 〈 /b 〉 CABG is currently the preferred therapy for complex LMCA disease; however, the long-term patency rates of these grafts are unsatisfactory, and stenting alone for LMCA may be associated with the potentially fatal consequences of stent thrombosis or restenosis. 〈 /p 〉 〈 p 〉 〈 b 〉 Methods: 〈 /b 〉 Between January 1997 and October 2005, 42 patients underwent staged bypass surgery and BMS, with the latter procedure performed 2 weeks after the initial CABG. Of these patients, 40 received left internal mammary artery (LIMA) grafts, 34 saphenous vein grafts, 6 radial artery grafts, and 3 right IMA (RIMA) grafts. Minimally invasive bypass surgery was performed in 10 patients. 〈 /p 〉 〈 p 〉 〈 b 〉 Results: 〈 /b 〉 There were no operative complications. Forty-two stents were implanted in 42 lesions without complications. During the follow-up period of 135 � 55 months, 1 patient died of cancer, 2 of cardiac causes, and 5 patients (12%) experienced target lesion revascularization. The target vessel failure rate was 24%. Forty patients (95%) underwent a 6-month angiographic follow-up. Restenosis was noted in 7 patients (18%). Reocclusion was also noted in 5 LIMA grafts, 5 saphenous vein grafts, 1 radial artery graft, and 1 RIMA graft. Only 1 patient experienced both restenosis of LM stenting and total occlusion of the 2 bypass grafts. 〈 /p 〉 〈 p 〉 〈 b 〉 Conclusions: 〈 /b 〉 Dual protection therapy with staged CABG and stenting is not an appropriate therapeutic strategy because of unacceptable graft patency rate. A higher occlusive rate of the bypass grafts may result from decreased blood flow because of competing blood flow between the bypass graft and the native coronary vessel. 〈 /p 〉
Type of Medium:
Online Resource
ISSN:
1522-6662
,
1098-3511
DOI:
10.1532/HSF98.2013282
Language:
Unknown
Publisher:
Forum Multimedia Publishing LLC
Publication Date:
2014
detail.hit.zdb_id:
2069230-4
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