Surgical management of left main coronary artery stenosis: a study about 148 cases

摘要

Advances in medical treatment and percutaneous intervention techniques have allowed encompassing patients with more severe coronary artery disease. However, several studies have demonstrated a significant benefit following surgical management of left main coronary artery stenosis, while drug-eluting stents have not been established yet to be more efficient and safe in these high risk patients. Our study aimed to assess through our practice, the predictors of mortality after surgical management of left main coronary artery disease. From January 2004 to December 2012, 148 patients underwent coronary artery bypass grafting for left main coronary artery disease in the department of thoracic and cardio-vascular surgery of Abderrahmen Mami Hospital, Tunisia, with a mortality rate 20.3%. Age was a predictive factor of post-operative mortality. Among preoperative conditions, recent myocardial infarction (p=0.000), preoperative atrial fibrillation and the use of catecholamine were positively correlated with post-operative death. However, left ventricular dysfunction, right coronary artery stenosis and comorbidities such as diabetes didn't show significant impact on mortality. The number of grafts and the use of the heart lung machine were not correlated with mortality, but intra-aortic balloon pump, the use of blood products and catecholamine intra-operatively were significant predictors. Post-operatively, agitation, post-operative stroke, atrial fibrillation and reintubation were bad prognosis factors. Surgical treatment of left main coronary artery stenosis has been the gold standard for the management of left main coronary disease. Nevertheless, patients should be well selected, in terms of their conditions, in order to benefit from surgical treatment.