Related Experiment Videos
The LAST operation is safe and effective: MIDCABG clinical and angiographic evaluation
A Repossini1, S Moriggia, V Cianci
1Cardiovascular Department, Cliniche Gavazzeni, Bergamo, Italy. arepossini@clinichegavazzeni.bg.it
Insights
Minimally invasive coronary artery bypass grafting using left internal mammary artery to left anterior descending artery anastomosis on a beating heart demonstrates excellent graft patency and safety. This approach offers a viable alternative to traditional bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Interventional Cardiology
Background:
- Coronary artery disease necessitates revascularization.
- Minimally invasive techniques aim to reduce surgical trauma.
- Evaluating novel surgical approaches is crucial for improving patient outcomes.
Purpose of the Study:
- To prospectively assess the angiographic results of minimally invasive coronary artery revascularization.
- To evaluate the efficacy and safety of left internal mammary artery to left anterior descending artery anastomosis.
- To determine graft patency rates in patients undergoing off-pump coronary artery bypass surgery.
Main Methods:
- 150 consecutive patients underwent left internal mammary artery to left anterior descending artery anastomosis.
- The procedure was performed on a beating heart via a left minithoracotomy.
- Angiographic evaluation was conducted post-procedure to assess graft patency.
Main Results:
- 100% in-hospital graft patency was observed in 149 angiographically controlled patients.
- 99.3% of anastomoses showed no anomalies.
- Morbidity included 3.3% postoperative bleeding requiring reoperation and 2% intraoperative myocardial infarction.
Conclusions:
- Left internal mammary artery to left anterior descending artery anastomosis on a beating heart is a safe and effective alternative for myocardial revascularization.
- This minimally invasive approach avoids cardiopulmonary bypass risks and demonstrates high-quality anastomoses.
- Favorable midterm clinical outcomes support the use of this technique.
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.