The use of "LAST" operation in high risk patient

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Interventional Cardiology

Background:

• The Left Anterior Descending (LAD) revascularization via the LAST operation is a suitable choice for single-vessel revascularization, despite some limitations.
• Hybrid procedures have been previously explored for multivessel revascularization.
• This study presents initial findings on the LAST operation in high-risk patient populations.

Purpose of the Study:

• To evaluate the preliminary outcomes of the LAST operation in high-risk patients undergoing coronary revascularization.
• To assess the safety and efficacy of minimally invasive LAD revascularization in a challenging patient group.

Main Methods:

• Eleven high-risk male patients (mean age 74 ± 8 years) with proximal LAD lesions unsuitable for PTCA underwent the LAST operation.
• Patients had high predicted mortality (EUROSCORE 29%, Parsonnet 31%) and a mean ejection fraction of 42 ± 5%.
• The procedure involved harvesting the Left Internal Mammary Artery (LIMA) through a small incision and performing an anastomosis to the LAD.

Main Results:

• No hospital or late mortality was recorded in the study cohort.
• One patient required conversion to midline sternotomy due to insufficient mammary artery flow.
• All patients were discharged within the first postoperative week, indicating a favorable short-term recovery.

Conclusions:

• The LAST operation demonstrates potential for enhancing minimally invasive surgical options in high-risk patients requiring coronary revascularization.
• This approach may expand the applicability of minimally invasive techniques to complex cardiac cases.