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Midterm results after minimally invasive coronary surgery (LAST operation)
A M Calafiore1, G Di Giammarco, G Teodori
1Department of Cardiac Surgery, University G. D'Annunzio of Chieti, Italy.
Insights
Left anterior small thoracotomy for coronary artery bypass grafting provides good midterm outcomes. This minimally invasive approach achieved satisfactory graft patency and patient survival rates, especially with increased surgical experience.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Review of experience with left internal thoracic artery (LITA) to left anterior descending (LAD) artery bypass grafting.
- Utilizing a left anterior small thoracotomy approach for LITA-LAD bypass.
Purpose of the Study:
- Evaluate the midterm results of LITA-LAD bypass via left anterior small thoracotomy.
- Assess graft patency, patient survival, and complication rates.
Main Methods:
- Retrospective review of 460 patients scheduled for LITA-LAD bypass via left anterior small thoracotomy.
- 434 patients underwent the procedure; 214 with isolated LAD disease, 220 with multivessel disease.
- Data collected on extubation time, ICU and hospital stay, mortality, reoperations, and angiographic/Doppler flow assessments.
Main Results:
- 30-day mortality was 1.1%, late mortality was 1.4%. Mean ICU stay was 4.2 hours, mean hospital stay 66 hours.
- Graft patency was 98.9% and nonrestrictive anastomosis 97.4% in the latter part of the experience.
- 29-month survival was 97.1% and event-free survival 89.4%.
Conclusions:
- Left anterior small thoracotomy is an acceptable approach for LITA-LAD bypass with favorable midterm outcomes.
- Satisfactory rates of patent and nonrestrictive anastomoses were achieved, particularly after mastering the surgical learning curve.
Background:
Our experience with a left internal thoracic artery graft to the left anterior descending artery via a left anterior small thoracotomy is reviewed to evaluate midterm results.
Methods:
From November 1994 to April 1997, four hundred sixty patients were scheduled to undergo a left internal thoracic artery graft to the left anterior descending coronary artery via a left anterior small thoracotomy; 26 of these patients (5.7%) were converted and 434 of them had the operation. Two hundred fourteen patients (49.3%) had isolated disease of the left anterior descending artery, and 220 patients (50.7%) had multiple vessel disease. A sufficient length of the left internal thoracic artery was harvested to reach the left anterior descending artery.
Results:
Three hundred nine patients (71.2%) underwent extubation by hour 2. Mean intensive care unit stay was 4.2 +/- 4.5 hours; mean postoperative hospital stay was 66 +/- 29 hours; the 30-day mortality rate was 1.1%; the late mortality rate was 1.4%. Eighteen patients underwent reoperation early (< or = 30 days), and eight patients underwent reoperation late (> 30 days) because of conduit/anastomotic malfunction. Four patients underwent reoperation with patent anastomosis for progression of disease (n = 3) or pericarditis (n = 1). Three patients had a percutaneous transluminal coronary angioplasty. Cumulating angiographic and stress Doppler flow assessment results, a patent anastomosis was obtained in 417 patients and a nonrestrictive anastomosis in 404 patients. Twenty-nine months after surgery, survival was 97.1% +/- 0.7% (95% confidence interval 90.5% to 100%) and event-free survival 89.4% +/- 1.2% (95% confidence interval 78.2% to 100%). In the last 190 patients, with our increased experience and better instruments, we obtained a patent anastomosis in 188 patients (98.9%) and a nonrestrictive anastomosis in 185 (97.4%).
Conclusions:
Left anterior small thoracotomy gives acceptable midterm results. Incidence of patent and nonrestrictive anastomoses was satisfactory, especially in the most recent part of our experience, when the learning curve ended.