To assess the effect of LIMA patch as a method for the reconstruction on diffusely diseased LAD in the early and midterm outcomes

It is well-known that coronary artery bypass graft (CABG) surgery significantly increases life expectancy, so complete myocardial revascularization should be the main goal of the surgical intervention process (1). During coronary artery bypass surgery, the surgeon removes a piece of blood vessel from the leg, chest, arm, or belly. Then, the surgeon uses that piece of blood vessel (called a "graft") to reroute blood around the blocked artery. The surgery is called "bypass surgery" because it bypasses the blockage Complete revascularization in CABG is crucial to improve early and late outcomes after surgery. Conventional procedures cannot achieve satisfactory results in severely diseased left anterior descending coronary artery .

Endarterectomy for severely atherosclerotic coronary artery disease (CAD) has a higher surgical risk and poor late outcomes . Reconstruction of diffusely diseased LAD with left internal mammary artery (LIMA) on-lay patch has less risk and complications than endarterectomy technique Ogus and colleagues used LIMA on-lay patches for the reconstruction of LAD based on the superior patency rate of the LIMA over other techniques which are more time-consuming. According to Lüscher and colleagues , the advantage of LIMA on-lay patch is to provide better vasomotor function and adjust the flow rate in proportion to the distal runoff.

In the recent study by Rezk etal., reported that , LAD reconstruction with a LIMA patch could have a better short-term outcome than other techniques as saphenous vein patch without an endarterectomy for a diffusely diseased left anterior descending coronary artery.

Inclusion Criteria:

• Any patient male,( or female) and his(or her) age from 30-90 years have Ischemic Heart Disease for CABG with diffusely diseased LAD.

Exclusion Criteria:

• Any patient performed open heart surgery before

Perioperative data values were coded, processed and collected in tables. Qualitative data were described using number and percent. Quantitative data were described using median and standard deviation. Statistical significance was assumed if a p value of 0.05 or less was achieved.