Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Background: Ischemic heart disease is one of the most common fatal diseases in the world. Especially patients with a diffusely diseased LAD that is frequently encountered, complete myocardial revascularization is hardly achieved by conventional bypass techniques and the long-term patency of a LIMA to LAD is usually jeopardized by the multiple atheromatous plaques. Several technical variations and surgical combinations have been suggested to reconstruct the diffusely diseased LAD that included: jumping anastomosis and creation of more than one bypass to the LAD territory, venous patch angioplasty followed by LIMA anastomosed on the patch and extended LIMA patch angioplasty. Methodology: Thirty patients underwent the study from July 2016 till December 2016. They were classified into two groups, 15 patients each, group A LAD angioplasty was done by LIMA patch and group B LAD angioplasty was done by SVG patch then LIMA anastomosed on the patch. Preoperative, operative, and postoperative data were analyzed and evaluated for early outcomes of both techniques. Results: Aortic cross Clamp time, total bypass time, hours of ventilation, duration of ICU stay, postoperative ECG changes, postoperative cardiac enzymes and echocardiography after 1 month are showing nearly the same results for both techniques in reconstructing the diffusely diseased left anterior descending coronary artery (LAD). Conclusion: LIMA patch technique and SVG patch technique are safe methods for reconstructing diffusely diseased LAD with early good results

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