title: Minimally invasive coronary artery surgery: the last operation.
abstract: Left anterior descending grafting with a left internal thoracic artery on a beating heart via a small left anterior thoracotomy is a procedure that is becoming popular, even if not yet standardized. From November 21, 1994 through February 20, 1997, 411 patients underwent a small left anterior thoracotomy; 206 had single-vessel disease, 205 had multiple-vessel disease. The early mortality rate was 1.0% (4 patients); causes of death were cardiac, not operation-related in 3, and non-cardiac in 1. The late mortality rate was 1.4% (6 patients); causes of death were cardiac operation-related in 1, non-cardiac in 3. All patients had a postoperative Doppler-flow velocity assessment; 231 (56.2%) underwent an angiographic control during the first postoperative year. Some patients were selected, as every patient with conduit or anastomotic malfunction underwent angiography. The patency rate was 92.4% (214/231); perfect distal anastomoses were obtained in 87.0% (201/231). With increasing experience and new instruments for left internal thoracic artery harvesting and left anterior descending artery stabilization, from April 21, 1996, patency rate increased to 98.2% (107/109) and perfect patency rate to 95.4% (104/109); results are therefore improving with time. The left anterior small thoracotomy procedure gives acceptable midterm results and is a reasonable alternative to the median sternotomy when the left anterior descending artery needs to be grafted with the left internal thoracic artery.
authors.affiliation: Department of Cardiac Surgery, G. D'Annunzio Chieti University, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: G
authors.initials: G
authors.lastname: Teodori
authors.forename: G
authors.initials: G
authors.lastname: Di Giammarco
authors.forename: G
authors.initials: G
authors.lastname: Vitolla
authors.forename: M
authors.initials: M
authors.lastname: Contini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013895:Thoracic Arteries / Q000601:surgery; D013908:Thoracotomy; D016896:Treatment Outcome