Document Detail

Midterm results after minimally invasive coronary surgery (LAST operation)
MedLine Citation:
PMID:  9576208     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Our experience with a left internal thoracic artery graft to the left anterior descending artery via a left anterior small thoracotomy is reviewed to evaluate midterm results. METHODS: From November 1994 to April 1997, four hundred sixty patients were scheduled to undergo a left internal thoracic artery graft to the left anterior descending coronary artery via a left anterior small thoracotomy; 26 of these patients (5.7%) were converted and 434 of them had the operation. Two hundred fourteen patients (49.3%) had isolated disease of the left anterior descending artery, and 220 patients (50.7%) had multiple vessel disease. A sufficient length of the left internal thoracic artery was harvested to reach the left anterior descending artery. RESULTS: Three hundred nine patients (71.2%) underwent extubation by hour 2. Mean intensive care unit stay was 4.2 +/- 4.5 hours; mean postoperative hospital stay was 66 +/- 29 hours; the 30-day mortality rate was 1.1%; the late mortality rate was 1.4%. Eighteen patients underwent reoperation early (< or = 30 days), and eight patients underwent reoperation late (> 30 days) because of conduit/anastomotic malfunction. Four patients underwent reoperation with patent anastomosis for progression of disease (n = 3) or pericarditis (n = 1). Three patients had a percutaneous transluminal coronary angioplasty. Cumulating angiographic and stress Doppler flow assessment results, a patent anastomosis was obtained in 417 patients and a nonrestrictive anastomosis in 404 patients. Twenty-nine months after surgery, survival was 97.1% +/- 0.7% (95% confidence interval 90.5% to 100%) and event-free survival 89.4% +/- 1.2% (95% confidence interval 78.2% to 100%). In the last 190 patients, with our increased experience and better instruments, we obtained a patent anastomosis in 188 patients (98.9%) and a nonrestrictive anastomosis in 185 (97.4%). CONCLUSIONS: Left anterior small thoracotomy gives acceptable midterm results. Incidence of patent and nonrestrictive anastomoses was satisfactory, especially in the most recent part of our experience, when the learning curve ended.
A M Calafiore; G Di Giammarco; G Teodori; S Gallina; N Maddestra; L Paloscia; G Scipioni; T Iovino; M Contini; G Vitolla
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  115     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-05-19     Completed Date:  1998-05-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  763-71     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, University G. D'Annunzio of Chieti, Italy.
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MeSH Terms
Coronary Angiography
Coronary Disease / mortality,  surgery*
Follow-Up Studies
Internal Mammary-Coronary Artery Anastomosis / methods*,  mortality
Surgical Procedures, Minimally Invasive / methods
Survival Rate
Thoracotomy / methods*
Time Factors
Vascular Patency
Comment In:
J Thorac Cardiovasc Surg. 1999 Jun;117(6):1226-7   [PMID:  10383266 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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