TY - JOUR AU - Hsieh, I-Chang AU - Lin, Pyng-Jing AU - Chang, Shang-Hung AU - Hsieh, Ming-Jer AU - Lin, Fen-Chiung AU - Wu, Delon AU - Chen, Chun-Chi PY - 2014/03/14 Y2 - 2024/03/28 TI - 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 JF - The Heart Surgery Forum JA - HSF VL - 17 IS - 1 SE - DO - 10.1532/HSF98.2013282 UR - https://journal.hsforum.com/index.php/HSF/article/view/252 SP - E47-E53 AB - <p><b>Objective:</b> 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.</p><p><b>Background:</b> 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.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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.</p><p><b>Conclusions:</b> 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.</p> ER -