Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease

Rafaeli I.R.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-0495-2645

Pankov A.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-2681-4243

Getazheev K.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0001-5193-0556

Zhuravlev A.S.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-9130-707X

Chernysheva I.E.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1268-5145

Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease

Authors:

Rafaeli I.R., Pankov A.N., Getazheev K.V., Zhuravlev A.S., Chernysheva I.E., Semitko S.P.

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(6): 646‑650

DOI: 10.17116/kardio202417061646

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To cite this article:

Rafaeli IR, Pankov AN, Getazheev KV, Zhuravlev AS, Chernysheva IE, Semitko SP. Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(6):646‑650. (In Russ.)
https://doi.org/10.17116/kardio202417061646

Подписка 2025-2 (Russian Journal of Cardiology and Cardiovascular Surgery)

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OBJECTIVE

To determine the effect of diagonal branch bypass grafting on patency of internal mammary artery (IMA) anastomosed with the left anterior descending artery (LAD) depending on Medina classification and severity of stenosis.

MATERIAL AND METHODS

A retrospective study included 87 patients who underwent LAD bypass with IMA and diagonal branch bypass grafting with venous conduit. We estimated angiography data in 60±9 months after surgery. Patency of IMA conduits was 90.8%, venous grafts to diagonal branch — 82.8%.

RESULTS

Significant (>70%) stenosis between diagonal branch and distal LAD prevents competitive blood flow for IMA. Patency rate was 95.8%, 100% and 94.7% for Medina 1:1:1, 1:0:1 and 0:1:1, respectively. In Medina 1:1:0 and no significant stenosis between diagonal branch and LAD, IMA patency was only 60%. In Medina 1:0:0, IMA dysfunction was observed in 75% of cases regardless of severity of proximal LAD stenosis.

CONCLUSION

No significant stenosis between LAD and diagonal branch leads to iatrogenic competitive blood flow in LAD and subsequent IMA dysfunction. In such situations, simultaneous diagonal branch revascularization is not advisable.

Keywords:

competitive blood flow

coronary artery bypass grafting

internal mammary artery

venous conduit

Medina classification

Authors:

Rafaeli I.R.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-0495-2645

Pankov A.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-2681-4243

Getazheev K.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0001-5193-0556

Zhuravlev A.S.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-9130-707X

Chernysheva I.E.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1268-5145

Received:

30.04.2023

Accepted:

08.08.2023

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