Objective To introduce the technique of surgical patch angioplasty for the treatment of patients with isolated left main coronary artery stenosis. Methods Retrospective investigation of results of surgical patch angioplasty in patients with isolated left main coronary artery disease. Results All 8 patients who underwent left main coronary artery patch angioplasty survived with no major perioperative complications. One patient had recurrent angina and required coronary artery bypass grafting 6 months after patch angioplasty. All other patients were symptom free and had normal activity, at a mean follow-up of 5. 3 years. Conclusions Patch angioplasty can be used as an alternative surgical technique in cases of isolated left main coronary artery stenosis with no distal coronary artery disease. However, it may not be suitable for patients with significant left main coronary artery calcification.
Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.
ObjectivesTo systematically review the efficacy and safety of intravascular ultrasound (IVUS) and coronary angiography-guided percutaneous coronary intervention (PCI) in left main coronary artery disease. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the efficacy and safety of IVUS and coronary angiography-guided PCI in left main coronary artery disease from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 7 studies involving 7 777 patients were included. The results of meta-analysis showed that: compared with PCI guided by coronary angiography, the incidence of cardiac death (OR=0.45, 95%CI 0.34 to 0.61, P<0.000 01), myocardial infarction (OR=0.67, 95%CI 0.53 to 0.84, P=0.004), major adverse cardiovascular events (OR=0.46, 95%CI 0.34 to 0.61, P<0.000 01), total deaths (OR=0.54, 95%CI 0.44 to 0.67, P<0.000 01), and in-stent thrombosis (OR=0.28, 95%CI 0.18 to 0.45, P<0.000 01) occurred in PCI guided by IVUS were lower. The differences were statistically significant. However, there were no statistical significance in the incidence of target revascularization in PCI (OR=0.80, 95%CI 0.40 to 1.61, P=0.54) and revascularization of target lesions (OR=0.68, 95%CI 0.36 to 1.27, P=0.23) between two groups.ConclusionsCurrent evidence shows that the IVUS-guided PCI can decrease the incidence of cardiac death, myocardial infarction, MACEs, stent thrombosis, total death and has no effect on target lesion revascularization and target vessel revascularization. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.