THE LAST OPERATION - TECHNIQUES AND RESULTS BEFORE AND AFTER THE STABILIZATION ERA

Background. Left anterior descending artery stabilization allows perfo rmance of left internal mammary artery grafting via a left anterior sm all thoracotomy on a beating heart. Our surgical experience was review ed to assess if surgical results have improved as result of specialize d instrumentation. Methods. Of 545 patients who had the left anterior small thoracotomy operation, 261 underwent this procedure for single l eft anterior descending artery disease. Two groups were considered, be fore and after the use of specialized instrumentation: group A (n = 93 ), operated on from November 21, 1994, to April 20, 1996; and group B (n = 168), operated on from April 21, 1996, to December 1997. Results. Early mortality was similar in the two groups. The further revascular ization (operation or percutaneous transluminal coronary angioplasty) and the rate of occlusion of the conduit were higher in group A,wherea s anastomotic or conduit malfunction was not. Cumulating angiography a nd Doppler now evaluation, 92.5% of the anastomoses in group A and 98. 8% in group B (p = 0.026) were patent, and 90.3% in group A and 97.6% in group B (p = 0.031) were patent and not restrictive, At 19 months, survival was similar, but the event-free survival was higher in group B. Conclusions. Both left anterior descending artery stabilization and safer left internal mammary artery harvesting contributed to improve angiographic and clinical results after the left anterior small thorac otomy operation. (Ann Thorac Surg 1998;66:998-1001) (C) 1998 by The So ciety of Thoracic Surgeons.