Left mini-thoracotomy off-pump coronary revascularization.
OBJECTIVE
Stent restenosis is a common complication in angioplasty. Studies have shown better outcomes when the left internal thoracic artery (LITA) is anastomosed to the left anterior descending artery (LAD). Patient selection, operative technique and results for off-pump left mini-thoracotomy (LME) coronary surgery, as a pilot study, are presented.


METHODS
Eighteen patients (three women) with a mean age of 56.6 +/- 9.2 were operated on through a 9-14 cm LME to perform off-pump LITA to LAD anastomoses (14 patients) or diagonalis (DI) and LAD sequential anastomoses (4 men). The grafts were skeletonized during dissection and anastomoses were performed using 7-0 polypropylene running sutures. An access device (CardioThoracic Systems) allowed approach and coronary stabilization.


RESULTS
There were no deaths, conversion to sternotomy, transfusions or high enzyme levels. All patients were released from hospital on the 3rd to 5th postoperative days and returned to their day-to-day activities within 30 days. One woman was readmitted for angina, presented with graft occlusion, and a stent was implanted and one man was readmitted for wound infection. Future angiography was performed on six patients and showed patent grafts.


CONCLUSIONS
The operation was performed with low morbid-mortality, short hospital stays and without transfusions. Appropriate instruments and the ability of the surgeon to use his left hand, made this operation technically easy. Randomized studies may prove if there are sufficient clinical and economic benefits over the long term to make this surgery the first choice.
Gauze
Theófilo
T
Dr. Theófilo Gauze Heart-Surgery Clinic -Santa Casa de Campo Grande, MS. tgauze@cardiol.br
Rosa
Flávio de Almeida
Fde A
Salvi Junior
Waldir Ferreira de
WF
Tamazato
Elzio
E
D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome