Early results with the minimally invasive thoracotomy for myocardial revascularization.
OBJECTIVE
We report the early results of the left anterior descending artery revascularization through a minimally invasive thoracotomy, examining the main technical aspects of the operation.


METHODS
From January 1995 to September 1996, 51 patients underwent myocardial revascularization through a mini-thoracotomy on beating heart without cardiopulmonary bypass. The main indication to operation was limited lesions of the left anterior descending artery with contra-indications or high risk of failure of angioplasty. The position of the patient was the same than traditional surgery; the chest was opened on the fourth left intercostal space; the left internal mammary artery harvested under direct vision; temporary occlusion of the left anterior descending was obtained prevalently using 5-0 poliypropilene sutures; the anastomosis was performed with single or double 7-0 or 8-0 suture. In six patients the chest was closed and a conventional open-heart operation was performed due to internal mammary artery or left anterior descending unsuitability for minimally invasive revascularization. All the patients were submitted after operation to early angiographic control and/or a Doppler study of the mammary flow.


RESULTS
There was no intra-operative mortality. One patient had a postoperative myocardial infarction of the anterior-lateral wall of the left ventricle, and died after an emergency open-heart operation. In one case the patient was reopened after a few hours for a bleeding. Three patients showed various degrees of anastomotic stenosis at the angiographic control.


CONCLUSIONS
Several technical difficulties can play an important role in the operative outcome because a single repeated technical error could not fully explain these heterogeneous observed failures. The technique of myocardial revascularization through a left anterior small thoracotomy might present several critical points, particularly: (1) the harvesting of LIMA, meaning the preservation of integrity of the arterial wall and adequacy of the length; (2) the method of the temporary closure of the LAD during of the anastomosis; (3) the stabilization of the LAD and the surgical technique of the anastomosis; (4) the methods for intraoperative control of the patency of the anastomosis. All points mentioned have been thought in our experience to be causes of early failure.
Alessandrini
F
F
Department of Cardiac Surgery, A. Gemelli University Hospital, Catholic University, Rome, Italy.
Luciani
N
N
Marchetti
C
C
Guadino
M
M
Possati
G
G
D000368:Aged; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009204:Myocardial Revascularization / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome