Long Term Results of LAD Reconstruction with LIMA Patch in Patients with Multiple Significant LAD disease

Abstract Background Diffusely diseased left anterior descending (LAD) coronary artery with multiple significant stenoses is commonly encountered and is a surgically challenging condition. Aim This study aimed to evaluate the long-term patency of LAD reconstruction with a left internal mammary artery (LIMA) patch in patients with multiple significant LAD stenoses. Methods We enrolled 50 patients who presented with multi-vessel disease and multiple significant LAD stenoses between January 2012 and January 2022. The LAD was opened all the way through leaving the most proximal lesion until probe 1.5 can pass smoothly through the proximal and distal LAD. Then, the LIMA was widely opened, 1.3 times the LAD opening, and they were anastomosed in the usual way with long length anastomosis. All patients were discharged on a combination of aspirin and clopidogrel for the first year and then aspirin alone for life. Postoperatively, patients were followed-up using coronary CT angiography at 5- and 10-years intervals. Results The mean age of the studied patients was 59.08±2.06, and the highest percent (72%) were males. Hypertension, dyslipidemia, and diabetes mellitus comprised the common comorbidities (84%, 68%, and 54%, respectively). the mean ejection fraction was 49.29±3.5 and the mean EuroScore II was 1.02±0.37. The number of grafts was either 5 (8%), 4 (70%), or 3 (22%). Follow-up revealed LAD patency in all the assessed patients at 5 years (49, 98%) and 10-years (46, 92%), while we lost follow-up of 1 (2%) patient at 5 years and 4 (8%) patients at 10-years. Conclusion Reconstruction with LIMA patch was effective in maintaining long-term patency of LAD in patients with multiple significant LAD stenosis. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.