Evaluation of 56 Cases of Long Segment Anastomosis of Left Internal Thoracic Artery to Left Anterior Descending Artery in Rajaei Heart Center

Background: Long segment reconstruction of the diffusely diseased Left Anterior De- scending Artery (LAD) with Left Internal Thoracic Artery (LITA) has been shown to be beneficial for patients that have complicated, multiple and long segment lesions in LAD. In this prospective study we analyzed the results obtained with this technique. Methods: From Feb. 2007 to Feb. 2009, 56 patients were operated by this technique. LITA was used as a patch along the opened narrow segment of LAD from 2 to 8 centimeter. Data from all patients were collected and all patients worked up for post operative complications, like post operative MI, ECG changes, NIHA class, enzymatic changes, post operative bleeding and CT-Angiography were done between 6 to 18 months after operation in some cases. Results: 56 cases,42 male (75%)and 14 female (25%), from 43 to78 years with mean age of 59.8+_9.3 years with multiple and long segment lesions in LAD were included in this satudy. Preoperative risk factors were Hypertension (66.1%), Diabetes (57.1%), Hyperlipidemia (50%), cigarette smoking (50%), renal failure (1.8%) and positive family history (7.1%). 23 patients (41.1%) have had remote MI and 9 patients (16.1%) have had recent MI.Significant left main lesion were found in7 patients (12.5%), pe- ripheral vascular disease in 3 patients (5.3%) and preoperative arrhythmias in 2 pa- tients (3.6%). Mean number of grafts that were used in operations was 2.85 +_1.5 and other concomitant operations were done in 5 patients. Post operative complications were arrhythmias in 10 (17.8%), postoperative MI in 1 (1.8%), surgical bleeding in 7 (12.5%), infections in 3 (5.3%), plural effusion in 3(5.3%), tamponade in 2(3.6%), pericardial effusion in 1 (1.8%) and hemiparesia in 1 patient (1.8%). there was no mortality in these patients. Conclusion: Long segment and multiple lesions in LAD are difficult challenges for cardiac surgeons and in these situations; results of long-segment LAD reconstruction are very encouraging.