MIDTERM RESULTS AFTER MINIMALLY INVASIVE CORONARY SURGERY (LAST OPERATION)

Background: Our experience with a left internal thoracic artery graft to the left anterior descending artery via a left anterior small thora cotomy is reviewed to evaluate midterm results. Methods: From November 1994 to April 1997, four hundred sixty patients were scheduled to und ergo a left internal thoracic artery graft to the left anterior descen ding coronary artery via a left anterior small thoracotomy; 26 of thes e patients (5.7%) were converted and 434 of them had the operation. Tw o hundred fourteen patients (49.3%) had isolated disease of the left a nterior 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: Thre e hundred nine patients (71.2%) underwent extubation by hour 2. Mean i ntensive care unit stay was 4.2 +/- 4.5 hours; mean postoperative hosp ital 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 (less than or equal to 30 days), and eight patients underwent r eoperation late (>30 days) because of conduit/anastomotic malfunction. Four patients underwent reoperation with patent anastomosis for progr ession of disease (n = 3) or pericarditis (n = 1). Three patients had a percutaneous transluminal coronary angioplasty. Cumulating angiograp hic and stress Doppler flow assessment results, a patent anastomosis w as obtained in 417 patients and a nonrestrictive anastomosis in 404 pa tients. 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 pati ents, with our increased experience and better instruments, we obtaine d a patent anastomosis in 188 patients (98.9%) and a nonrestrictive an astomosis in 185 (97.4%). Conclusions: Left anterior small thoracotomy gives acceptable midterm results. Incidence of patent and nonrestrict ive anastomoses was satisfactory, especially in the most recent part o f our experience, when the learning curve ended.