Original articleThe LAST operation is safe and effective: MIDCABG clinical and angiographic evaluation
Section snippets
Material and methods
In the Cardiovascular Department of Cliniche Gavazzeni, Bergamo, Italy, from May 1997 to December 1998, 150 consecutive patients underwent LIMA to LAD anastomosis through a left minithoracotomy (MIDCABG) on a beating heart. No patient receiving only LIMA–LAD was operated on using full sternotomy (with or without cardiopulmonary bypass). In 4 patients (not included in our series) the operation was converted to median sternotomy for different reasons.
Candidates were patients with isolated LAD
Surgical and postoperative results
We performed 150 LIMA–LAD anastomoses on beating hearts without CPB through a left minithoracotomy.
Of the 58 patients with two-vessel disease, 38 were true bivascular patients (B), and 16 (42.1%) received an additional PTCA of the other coronary artery (hybrid procedure) during the same hospital stay. We decided to treat only severe stenosis on anatomically relevant second coronary artery. In case of subcritical stenosis or small branches, PTCA was performed only after scintigraphic evidence of
Comment
A minimally invasive coronary bypass surgical program was started at our center in May 1997, after a period of training in Chieti Hospital (Dr Calafiore) and in the “stabilization era” [4].
As LIMA patency is the most important determinant of survival and event-free survival after coronary revascularization [5], LAD stabilization allowed us to reproduce the conditions of the arrested heart in terms of anastomosis quality. As postoperative angiography is the gold standard in graft patency
References (10)
Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris
J Thorac Cardiovasc Surg
(1967)- et al.
The LAST operationtechniques and results before and after the stabilization era
Ann Thorac Surg
(1998) - et al.
Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass
Ann Thorac Surg
(1996) - et al.
Transient ischemia does not limit subsequent ischemic regional dysfunction in humansa transesophageal echocardiographic study during minimally invasive coronary artery bypass surgery
J Am Coll Cardiol
(1998) - et al.
Role of graft flow measurement technique in anastomotic quality assessment in minimally invasive CABG
Ann Thorac Surg
(1998)