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Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass
A M Calafiore1, G D Giammarco, G Teodori
1Department of Cardiac Surgery, G.D'Annunzio Chiefi University, Italy.
Insights
This study shows that connecting the left internal mammary artery (LIMA) to the left anterior descending artery on a beating heart using a small thoracotomy is safe. The procedure offers good early and midterm results for selected patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Exploration of left internal mammary artery (LIMA) to left anterior descending (LAD) artery anastomosis on a beating heart.
- Utilized a left anterior small thoracotomy approach for the procedure.
Purpose of the Study:
- To evaluate the safety and efficacy of LIMA-to-LAD anastomosis in a beating heart via a small thoracotomy.
- To assess early and midterm outcomes of this minimally invasive surgical technique.
Main Methods:
- Performed LIMA-to-LAD anastomosis in 155 patients using a beating heart technique.
- Utilized a left anterior small thoracotomy (mean wound length 10.5 cm) for access.
- Occluded LAD artery with Prolene sutures and performed anastomosis with 8/0 Prolene sutures.
Main Results:
- Successful anastomosis achieved in 144 patients directly and 11 with interposition grafts.
- Mortality rate was 0.6% (1 patient).
- Graft failure requiring reoperation occurred in 5.8% of patients; 92.2% were alive and asymptomatic at 5.6 months follow-up.
Conclusions:
- Left internal mammary artery-to-left anterior descending artery anastomosis on a beating heart via small thoracotomy is a safe procedure.
- The operation demonstrates favorable early and midterm outcomes in carefully selected patients.
- Minimally invasive approach offers a viable alternative for coronary revascularization.
Background:
We explored the possibility of anastomosing the left anterior internal mammary artery (LIMA) to the left anterior descending artery in a beating heart via a left anterior small thoracotomy.
Methods:
This procedure was performed in 155 of 162 scheduled patients; in 7 (4.3%) the left anterior descending artery was not suitable or was too small. The chest was opened in the fourth intercostal space (mean wound length, 10.5 cm) and the LIMA was harvested for about 4 cm. The left anterior descending artery was occluded by means of two 4/0 Prolene (Ethicon, Somerville, NJ) sutures, and the proximal suture was snared. The anastomosis was performed with two 8/0 Prolene sutures while the heart was beating. Early postoperatively all patients underwent repeat angiography or a Doppler flow assessment of the LIMA or both.
Results:
The LIMA was connected directly to the left anterior descending artery in 144 patients and with interposition of an inferior epigastric artery in 11. In 2 patients the diagonal branch was also grafted using an inferior epigastric artery from the LIMA. One patient (0.6%) died 38 days after the operation due to multiorgan failure. Nine patients (5.8%) had failure requiring a redo operation: 7 (4.5%) early and 2 (1.3%) late. One additional patient had a late percutaneous transluminal coronary angioplasty for anastomotic stenosis. At a mean 5.6 months of follow-up, 143 patients (92.2%) were alive, asymptomatic with or without medical treatment, and without cardiac events.
Conclusions:
Left internal mammary artery-to-left anterior descending artery anastomosis performed on a beating heart via a left anterior small thoracotomy is a safe procedure. In selected patients the operation has good early and midterm results.