Surgery for Chronic Total Occlusion of the Left Main Coronary Artery- Myocardial Preservation
| Autor: | Gokhan Ipek, Bahadir Daglar, Mustafa Güler, Suat Nail Omeroglu, Nihan Kayalar, Hasan Ardal, Cevat Yakut, Mesut Şişmanoğlu, Denyan Mansuroglu |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Coronary Artery Bypass Off-Pump Coronary Disease law.invention Lesion Coronary circulation law Internal medicine medicine.artery medicine Cardiopulmonary bypass Humans Myocardial infarction Coronary Artery Bypass Cardioplegic Solutions Aged Cardiopulmonary Bypass business.industry Middle Aged medicine.disease Coronary Vessels Surgery Treatment Outcome medicine.anatomical_structure Ventricle Right coronary artery Cardiology Myocardial preservation Female medicine.symptom Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Journal of Cardiac Surgery. 20:60-64 |
| ISSN: | 1540-8191 0886-0440 |
| DOI: | 10.1111/j.0886-0440.2005.200395.x |
| Popis: | We report seven patients with chronic total occlusion of the left main coronary artery that were operated in our institution and discuss the myocardial preservation options in these patients. In addition to total occlusion of the left main coronary artery, three patients also had severe lesions of right coronary artery. Prior myocardial infarction history and significantly depressed left ventricle functions were detected in all three patients with right coronary artery lesions. Five patients were operated on cardiopulmonary bypass while two patients were operated off pump. All patients received alternating antegrade/retrograde cardioplegia for myocardial preservation. In patients with simultaneous right coronary artery disease we first established the origin of the collaterals to the left coronary system. For patients with collaterals arising from the right coronary artery segment distal to the right coronary artery lesion, the antegrade component was administered through the saphenous vein graft bypassed to a distal part of right coronary artery segment. Thus we have achieved a more effective distribution of the antegrade cardioplegia. In off-pump-operated patients the left coronary system was revascularized before the right coronary system. Postoperative low cardiac output syndrome occurred in only one patient who was operated off pump. There was no operative and early mortality. Mean follow-up was 32 +/- 21.42 (range, 4 to 60) months. Alternating antegrade/retrograde cardioplegia was used with acceptable results in patients with total occlusion of the left main coronary artery. In patients with simultaneous RCA lesion we recommend regulation of the antegrade component based on the origin of collaterals that supplies the left coronary system. In off-pump-operated patients we suggest avoiding of clamping of right coronary artery at the beginning of the operation while it still supplies all the coronary circulation. |
| Databáze: | OpenAIRE |
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