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Antonio M. Calafiore
Giuseppe Vitolla
Valerio Mazzei
Giovanni Teodori
Gabriele Di Giammarco
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Ann Thorac Surg 1998;66:998-1001
© 1998 The Society of Thoracic Surgeons

Supplement

The LAST operation: techniques and results before and after the stabilization era

Antonio M. Calafiore, MDa, Giuseppe Vitolla, MDa, Valerio Mazzei, MDa, Giovanni Teodori, MDa, Gabriele Di Giammarco, MDa, Teresa Iovino, MDa, Angela Iaco’, MDa

a Division of Cardiac Surgery, "G. D’Annunzio" University, Chieti, Italy

Address reprint requests to Dr Calafiore, Division of Cardiac Surgery, "G. D’Annunzio" University, S Camillo de’Lellis Hospital, via C. Forlanini, 50 66100 Chieti, Italy
e-mail: (calafiore{at}unich.it)

Presented at "Facts and Myths of Minimally Invasive Cardiac Surgery: Current Trends in Thoracic Surgery IV," New Orleans, LA, Jan 24, 1998.

Abstract

Background. Left anterior descending artery stabilization allows performance of left internal mammary artery grafting via a left anterior small thoracotomy on a beating heart. Our surgical experience was reviewed to assess if surgical results have improved as result of specialized instrumentation.

Methods. Of 545 patients who had the left anterior small thoracotomy operation, 261 underwent this procedure for single left anterior descending artery disease. Two groups were considered, before and after the use of specialized instrumentation: group A (n = 93), operated on from November 21, 1994, to April 20, 1996; and group B (n = 168), operated on from April 21, 1996, to December 1997.

Results. Early mortality was similar in the two groups. The further revascularization (operation or percutaneous transluminal coronary angioplasty) and the rate of occlusion of the conduit were higher in group A, whereas anastomotic or conduit malfunction was not. Cumulating angiography and Doppler flow evaluation, 92.5% of the anastomoses in group A and 98.8% in group B (p = 0.026) were patent, and 90.3% in group A and 97.6% in group B (p = 0.031) were patent and not restrictive. At 19 months, survival was similar, but the event-free survival was higher in group B.

Conclusions. Both left anterior descending artery stabilization and safer left internal mammary artery harvesting contributed to improve angiographic and clinical results after the left anterior small thoracotomy operation.




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