Peculiarity of Surgical Tactics for Management of Ischemic Heart Disease in patients with Left Main Coronary Artery Stenosis

Abstract

The left main coronary artery disease has poor natural history. Sudden death, massive myocardial infarction, angina and poor quality of life indicate the ominous nature of the disease. Coronary artery bypass grafting remains the ultimate choice of its management. A relatively high mortality and morbidity of its surgical treatment described in literature leads to the actuality of this disease. This work is a part of our continuous effort for refinements in anesthetic and surgical techniques to reduce mortality and morbidity in such patients and is in the clinical practice at our institute for the last few years. During the period from February 1998 to October 2005, 74 patients underwent coronary artery bypass surgery for left main coronary artery stenosis, at Federal Postgraduate Medical Institute, Shaikh Zayed Hospital. Lahore. All patients presented with angina, unstable in 62.2%. An old myocardial Infarction was present in 52 (70.3%) patients. An emergent surgery was needed in 5(6.8%), urgent operation was performed in 45(60.8%) patients and elective procedure was done in 24(32.4%). Average stay in the hospital was 9.0±2.7 days. There were 2 hospital deaths and one late non cardiac death. The post-operative recovery was eventless in majority of the patients. The return of patients to their jobs improved significantly (P <0.005) three months after operation. Our current surgical results are certainly improved than many previous studies on coronary artery bypass grafting for left main stem stenosis.