LEFT ANTERIOR DESCENDING CORONARY-ARTERY GRAFTING VIA LEFT ANTERIOR SMALL THORACOTOMY WITHOUT CARDIOPULMONARY BYPASS

Background. We explored the possibility of anastomosing the left inter nal mammary artery (LIMA) to the left anterior descending artery in a beating heart via a left anterior small thoracotomy. Methods. This pro cedure was performed in 155 of 162 scheduled patients; in 7 (4.3%) the left anterior descending artery was not suitable or was too small. Th e chest was opened in the fourth intercostal space (mean wound length, 10.5 cm) and the LIMA was harvested for about 4 cm. The left anterior descending artery was occluded by means of two 4/0 Prolene (Ethicon, Somerville, NJ) sutures, and the proximal suture was snared. The anast omosis was performed with two 8/0 Prolene sutures while the heart was beating. Early postoperatively all patients underwent repeat angiograp hy or a Doppler flow assessment of the LIMA or both. Results. The LIMA was connected directly to the left anterior descending artery in 144 patients and with interposition of an inferior epigastric artery in 11 . In 2 patients the diagonal branch was also grafted using an inferior epigastric artery from the LIMA. One patient (0.6%) died 38 days afte r thp operation due to multiorgan failure. Nine patients (5.8%) had fa ilure requiring a redo operation: 7 (4.5%) early and 2 (1.3%) late. On e additional patient had a late percutaneous transluminal coronary ang ioplasty for anastomotic stenosis. At a mean 5.6 months of follow-up, 143 patients (92.2%) were alive, asymptomatic with or without medical treatment, and without cardiac events. Conclusions. Left internal mamm ary artery-to-left anterior descending artery anastomosis performed on a beating heart via a left anterior small thoracotomy is a safe proce dure. In selected patients the operation has good early and midterm re sults.