Integrated left anterior small thoracotomy and angioplasty for coronary artery revascularization

Background. The minimal access surgical technique of a left anterior small thoracotomy (LAST) for coronary artery bypass grafting is now well establis hed. This procedure however, does not allow multivessel revascularization. We present our early experience of an integrated approach using LAST and pe rcutaneous transluminal coronary angioplasty (PTCA), either staged or simul taneous. Methods. Eighteen patients (14 men and 4 women), mean age 63 (range 35-87 y ears) were treated. Four patients underwent simultaneous LAST and PTCA reva scularization. The remaining 14 patients were first treated with the LAST p rocedure, followed 1-3 days later by angioplasty. Angiographic assessment w as carried out before PTCA and at 6 months after. Results. The 14 patients who underwent the staged procedure all had patent left internal mammary artery/left anterior descending coronary artery graft s. Angioplasty was performed on 21 vessels (10 stented) with good early ang iographic results. All patients were extubated early, mean intensive care s tay was 14.7 +/- 9.4 hours, mean hospital stay was 5 +/- 1.5 days. All pati ents were symptom free at 18 months follow-up. Conclusions. Staged LAST and angioplasty is a safe and effective approach s uitable for patients in whom there are contraindications to the use of extr acorporeal circulation. The simultaneous approach is limited by the risk of bleeding associated with the use of anticoagulation when coronary stenting is required. (Ann Thorac Surg 1999;68:908-12) (C) 1999 by The Society of T horacic Surgeons.