Left anterior small thoracotomy (LAST): mid-term results in single vessel disease

Left anterior descending artery grafting using the left internal mammary artery via a left anterior small thoracotomy (LAST) gained new popularity in 1994. We review our experience in 250 of 512 patients who underwent a LAST in single vessel left anterior descending artery disease from November 1994 to October 1997.

Left anterior descending artery stabilization was obtained pharmacologically and mechanically. Two patients (0.8%) had percutaneous transluminal coronary angioplasty at a mean of 23 +/- 5 days; 172 (68.8%) patients had early postoperative angiography.

Eight conduits were occluded (patency rate 95.3%). There was only one late death. Cumulative angiography and Doppler flow evaluation showed that 96.8% of the anastomoses were patent and 95.6% were both patent and nonrestrictive. At a mean follow-up of 16.3 +/- 9.3 months, 9 (3.6%) patients had redo-surgery due to anastomotic/conduit failure and 249 (99.6%) patients were alive and asymptomatic. No patients had acute myocardial infarction. The 35-month actuarial survival rate was 99.6% +/- 0.4%, and the event-free survival rate for the entire experience was 93.7% +/- 1.3%. If only the last 157 patients are considered, at 18 months event-free survival was higher than in the entire group of patients (96.4% +/- 1.4% vs 93.7% +/- 1.3%, p = 0.05).

New instrumentation has made the operation easier and has contributed to its spread, along with increased experience and the end of the learning curve. At the moment we consider the LAST a more anatomical and physiological surgical approach to single vessel coronary disease.