Surgical treatment of left main coronary artery stenosis

Clinical experience and follow-up of patients operated on with surgical arterial patch angioplasty of the left main coronary artery (LMCA) and observational retrospective studies in patients with LMCA obstruction who had undergone coronary artery bypass grafting (CABG) are reported. Patients: Forty-three patients were operated on with LMCA angioplasty during 1997 - 2003. Twelve patients were operated with an posterior approach and in 31 subsequent patients an aortic transsection technique was used. Additional bypass grafts were inserted in 21 patients (49%). Follow-up at a mean of 45 (range, 7 to 79) months included a stress test, echocardiography, and angiography with intravascular ultrasound of the LMCA. A total of 552 patients with documented LMCA obstruction had isolated primary CABG during 1970 - 1989. In 384 patients with an available angiography, feasibility of surgical angioplasty, severity of obstruction and survival were analyzed. In 496 patients the LMCA obstruction was obstructed classified as Iow- or high-grade or a completely occluded LMCA. Early (