title: Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, G.D'Annunzio Chiefi University, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: G D
authors.initials: GD
authors.lastname: Giammarco
authors.forename: G
authors.initials: G
authors.lastname: Teodori
authors.forename: G
authors.initials: G
authors.lastname: Bosco
authors.forename: E
authors.initials: E
authors.lastname: D'Annunzio
authors.forename: A
authors.initials: A
authors.lastname: Barsotti
authors.forename: N
authors.initials: N
authors.lastname: Maddestra
authors.forename: L
authors.initials: L
authors.lastname: Paloscia
authors.forename: G
authors.initials: G
authors.lastname: Vitolla
authors.forename: A
authors.initials: A
authors.lastname: Sciarra
authors.forename: C
authors.initials: C
authors.lastname: Fino
authors.forename: M
authors.initials: M
authors.lastname: Contini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002315:Cardiopulmonary Bypass; D003251:Constriction, Pathologic / Q000628:therapy; D017023:Coronary Angiography; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D019074:Epigastric Arteries / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D009200:Myocardial Contraction; D011126:Polypropylenes; D012086:Reoperation; D015996:Survival Rate; D013536:Suture Techniques; D013537:Sutures; D013908:Thoracotomy / Q000379:methods*; D017211:Treatment Failure
chemical_list: D011126:Polypropylenes