Dual Protection Therapy with Staged Coronary Artery Bypass Surgery and Stenting in Patients with Left Main Coronary Artery Stenosis: Long-Term Results from a Single Center


  • I-Chang Hsieh
  • Pyng-Jing Lin
  • Shang-Hung Chang
  • Ming-Jer Hsieh
  • Fen-Chiung Lin
  • Delon Wu
  • Chun-Chi Chen




Objective: We evaluated the efficacy and safety of dual protection therapy with staged coronary artery bypass grafting (CABG) and bare-metal stenting (BMS) in patients with left main coronary artery (LMCA) disease.

Background: CABG is currently the preferred therapy for complex LMCA disease; however, the long-term patency rates of these grafts are unsatisfactory, and stenting alone for LMCA may be associated with the potentially fatal consequences of stent thrombosis or restenosis.

Methods: Between January 1997 and October 2005, 42 patients underwent staged bypass surgery and BMS, with the latter procedure performed 2 weeks after the initial CABG. Of these patients, 40 received left internal mammary artery (LIMA) grafts, 34 saphenous vein grafts, 6 radial artery grafts, and 3 right IMA (RIMA) grafts. Minimally invasive bypass surgery was performed in 10 patients.

Results: There were no operative complications. Forty-two stents were implanted in 42 lesions without complications. During the follow-up period of 135 ± 55 months, 1 patient died of cancer, 2 of cardiac causes, and 5 patients (12%) experienced target lesion revascularization. The target vessel failure rate was 24%. Forty patients (95%) underwent a 6-month angiographic follow-up. Restenosis was noted in 7 patients (18%). Reocclusion was also noted in 5 LIMA grafts, 5 saphenous vein grafts, 1 radial artery graft, and 1 RIMA graft. Only 1 patient experienced both restenosis of LM stenting and total occlusion of the 2 bypass grafts.

Conclusions: Dual protection therapy with staged CABG and stenting is not an appropriate therapeutic strategy because of unacceptable graft patency rate. A higher occlusive rate of the bypass grafts may result from decreased blood flow because of competing blood flow between the bypass graft and the native coronary vessel.


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How to Cite

Hsieh, I.-C., Lin, P.-J., Chang, S.-H., Hsieh, M.-J., Lin, F.-C., Wu, D., & Chen, C.-C. (2014). Dual Protection Therapy with Staged Coronary Artery Bypass Surgery and Stenting in Patients with Left Main Coronary Artery Stenosis: Long-Term Results from a Single Center. The Heart Surgery Forum, 17(1), E47-E53. https://doi.org/10.1532/HSF98.2013282




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