Clinical outcome after composite grafting of calcified left anterior descending arteries.

AIM The treatment of a severely calcified left anterior descending coronary artery (LAD) remains a challenge in cardiac surgery. The objective of this retrospective study was to assess the early clinical outcome obtained from LAD reconstruction, which was performed using a combination of both, saphenous vein and the left internal thoracic artery (LITA) as a composite graft, in order to achieve complete revascularization. METHODS Between January 1998 and December 2003, 71 patients, 13 female and 58 male, with a mean age of 67+/-9.12 years were retrospectively analyzed. All patients suffered from a severe 3-vessel disease with a diffusely calcified LAD. The design of the reconstruction consisted in a long arteriotomy of the LAD grafted with a matched segment of the saphenous vein using the plaque exclusion technique to avoid endarterectomy. The LITA was then anastomosed to the saphenous vein in an end-to-end configuration. With this design, the saphenous vein was used first as a ''patch'' reconstruction of the LAD and second as an elongation for the LITA. The clinical outcome was assessed by mailed questionnaires or by telephone interview with the responsible cardiologist or general practitioner. RESULTS The follow-up was 100%, comprising a mean follow-up time of 17+/-11.8 months. Overall mortality was 7% (N=5/71). Four cardiac deaths and 1 non cardiac-related death were registered. The in-hospital mortality was 2.8% (2/71); 2 cardiac-related deaths and one non cardiac-related death were observed after 30 days (4.2%). Postoperative myocardial infarction without heart failure was seen in 4 patients (5.4%). In addition, an episode of transitory cerebral ischemia was observed in 1 patient (1.4%). No further postoperative complications occurred. At the time of evaluation, 67% of the patients were in functional class CCS 0 and 33% in functional class CCS I to II. CONCLUSIONS Composite graft reconstruction without endarterectomy is an alternative treatment option for severely calcified LADs with a good early clinical outcome.