Surgery for chronic total occlusion of the left main coronary artery

BACKGROUND AND OBJECTIVES: Chronic total occlusion of the left main coronary artery (LMCA) is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart (OnP-BH) technique. DESIGN AND SETTING: Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period (1999 to 2009). PATIENTS AND METHODS: The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed. RESULTS: The mean extracorporeal circulation period was 80.4 (19.7) minutes. The mean intubation duration was 13.0 (4.6) hours. The mean intensive care unit stay period was 3.2 (0.7) days, and the mean discharge period was 16.8 (3.3) days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 (34.8) months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function. CONCLUSIONS: The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA.