The LAST operation is safe and effective: MIDCABG clinical and angiographic evaluation

Background. The aim of this study was to prospectively evaluate the angiogr aphic results of a cohort of consecutive patients who underwent minimally i nvasive coronary artery revascularization. Methods. From May 1997 to December 1998, 150 consecutive patients underwent left internal mammary artery to left anterior descending artery anastomosi s through a left minithoracotomy on a beating heart in the Cardiovascular D epartment of Cliniche Gavazzeni, Bergamo, Italy. The mean age was 61.6 year s (range, 36 to 84 years); 121 patients (81%) were men. Isolated left anter ior descending artery disease was present in 74 patients. Results. In-hospital patency was observed in 100% of the 149 angiographical ly controlled patients with no anomalies in 99.3% of the anastomoses. Anast omosis was performed on a diseased tract of the target vessel in 3 patients and a stenosis of the target vessel beyond the anastomosis was documented in 3 patients. In one case early angiographic control was not performed due to death of the patient on the Ist postoperative day. The morbidity includ ed postoperative bleeding that required reopening (3.3%) and intraoperative myocardial infarction (2%). Conclusions. A left internal mammary artery to left anterior descending art ery anastomosis on a beating heart through a left minithoracotomy is an alt ernative approach to myocardial revascularization. Surgical invasiveness is limited, cardiopulmonary bypass risks are avoided, and the procedure is sa fe and effective. In our consecutive series, postoperative angiographic con trols demonstrated graft patency in all patients and very high quality anas tomoses. Midterm clinical follow-up (14 months) appears favorable. (Ann Tho rac Surg 2000;70:74-8) (C) 2000 by The Society of Thoracic Surgeons.