title: The use of "LAST" operation in high risk patient.
abstract: BACKGROUND
  The LAST operation, in spite of few drawbacks, represents a good option for single Left Anterior Descending (LAD) revascularization. This procedure does not allow multivessel revascularization, where hybrid procedure have been previous described. We report preliminary experience with the LAST operation performed in high risk patients.
  
  
  METHODS
  From October 2004 to February 2005, 11 male high risk patients (mean age 74 +/- 8 years) underwent the LAST operation. Mean predicted death with EUROSCORE and Parsonnet score were 29% and 31% respectively. All patients had a proximal LAD lesion either not suitable for PTCA and multivessel coronary artery disease. The mean preoperative Ejection Fraction was 42 +/- 5% (27-55%). Four patients (36.4%) had previous surgical myocardial revascularization. An incision of about 6 cm was made in the appropriate intercostal space and the LIMA (Left Internal Mammary Artery) was harvested using a special costal retractor. After heparin administration the LIMA is distally divided to check the adequacy of the blood flow. Following the insertion of a temporary intracoronary shunt, the LIMA was LAD anastomosis was carried out with a continuous 8-0 polypropylene suture.
  
  
  RESULTS
  No hospital or late mortality was observed. Uneventful conversion to midline sternotomy was necessary in one patient with low value of mammary flow. All patients were discharged within the first postoperative week.
  
  
  CONCLUSIONS
  The use of the LAST operation enhances the role of minimally invasive surgery also in high risk patients who need coronary revascularization.
authors.affiliation: Division of Cardiac Surgery, San Sebastiano Hospital, Via Tescione, 81100 Caserta, Italy. gennaroismeno@yahoo.com
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ismeno
authors.forename: Antonio
authors.initials: A
authors.lastname: Falco
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Tritto
authors.forename: Antonio
authors.initials: A
authors.lastname: Dangelo
authors.forename: Francesco
authors.initials: F
authors.lastname: Longobardi
authors.forename: Girolamo
authors.initials: G
authors.lastname: Damiani
authors.forename: Joseph
authors.initials: J
authors.lastname: Marmo
authors.forename: Rosario
authors.initials: R
authors.lastname: Gregorio
authors.forename: Luigi
authors.initials: L
authors.lastname: Piazza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome