Surgical Treatment for Diffuse Coronary Artery Diseases

Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery lesions, for which endarterectomy is a way but it’s not feasible to thin coronary artery without inner lumen or to the immature plaque. In this case, it may be a proper therapeutic option to achieve coronary revascularization by retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass grafting (CVBG). [1] Saphenous veins could be used to realize arterialization for great or middle cardiac vein by separate or sequential bypass grafting. But it would cause myocardial hemorrhage, edema and even heart failure due to excessive perfusion by high pressure [2]. However, internal mammary artery (IMA), as one kind of muscular artery materials, can enlarge or contract its lumen to adjust the blood flow with strong adaptability [3]. Off-pump coronary artery bypass surgery (OPCAB) has been widely applied as a less invasive method of myocardial revascularization in recent years. It could avoid the systemic inflammatory effects caused by cardiopulmonary bypass (CPB). OPCAB has more merits such as low mortality, low morbidity, and reduced costs, especially in high risk patients [4]. Therefore, sequential bypass of bilateral IMA combined with arterialization for middle cardiac vein were carried out during OPCAB for patients with diffuse lesions existing in right coronary artery.