Original article
The LAST operation is safe and effective: MIDCABG clinical and angiographic evaluation

https://doi.org/10.1016/S0003-4975(00)01413-2Get rights and content

Abstract

Background. The aim of this study was to prospectively evaluate the angiographic results of a cohort of consecutive patients who underwent minimally invasive coronary artery revascularization.

Methods. From May 1997 to December 1998, 150 consecutive patients underwent left internal mammary artery to left anterior descending artery anastomosis through a left minithoracotomy on a beating heart in the Cardiovascular Department of Cliniche Gavazzeni, Bergamo, Italy. The mean age was 61.6 years (range, 36 to 84 years); 121 patients (81%) were men. Isolated left anterior descending artery disease was present in 74 patients.

Results. In-hospital patency was observed in 100% of the 149 angiographically controlled patients with no anomalies in 99.3% of the anastomoses. Anastomosis was performed on a diseased tract of the target vessel in 3 patients and a stenosis of the target vessel beyond the anastomosis was documented in 3 patients. In one case early angiographic control was not performed due to death of the patient on the 1st postoperative day. The morbidity included postoperative bleeding that required reopening (3.3%) and intraoperative myocardial infarction (2%).

Conclusions. A left internal mammary artery to left anterior descending artery anastomosis on a beating heart through a left minithoracotomy is an alternative approach to myocardial revascularization. Surgical invasiveness is limited, cardiopulmonary bypass risks are avoided, and the procedure is safe and effective. In our consecutive series, postoperative angiographic controls demonstrated graft patency in all patients and very high quality anastomoses. Midterm clinical follow-up (14 months) appears favorable.

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

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