Background. We reviewed our experience with left internal mammary arte
ry (LIMA)-to-left anterior descending artery (LAD) anastomosis on a be
ating heart through a left anterior small thoracotomy. Methods. This p
rocedure was performed in 343 of 358 scheduled patients; in 15 (4.2%)
the LAD was not suitable or was too small. The chest was opened in the
fourth (127, 37.0%) or fifth (197, 57.4%) intercostal space, or both
(19, 5.6%); the length of the harvested LIMA was 4-15 cm. The LAD was
occluded by means of two 4-0 Prolene (Ethicon, Somerville, NJ) sutures
, both snared on a small piece of silicone tubing. The anastomosis was
performed with two 8-0 Prolene sutures. In the early postoperative pe
riod all patients underwent angiography or a doppler flow assessment o
f the LIMA or both. Results. In 310 patients the LIMA was connected di
rectly to the LAD; to elongate the LIMA, in 30 patients an inferior ep
igastric artery and in 3 patients a saphenous vein was used. In 2 pati
ents the diagonal branch was also grafted using an inferior epigastric
artery from the LIMA. Three patients (0.9%) died during the first 30
days after the operation, and 4 other patients (1.2%) died after the f
irst month. Twenty-five patients (7.3%) were reoperated on because of
anastomotic or conduit failure, 18 (5.2%) early and 7 (2.1%) late; one
additional patient had a late percutaneous transluminal coronary angi
oplasty for anastomotic stenosis. At a mean of 9.5 +/- 5.7 months of f
ollow-up, 336 patients (98.0%) were alive, asymptomatic with or withou
t medical treatment, and without cardiac events. Comment. Left interna
l mammary artery-to-LAD anastomosis performed on a beating heart throu
gh a left anterior small thoracotomy is a procedure that can be perfor
med with low risk and acceptable midterm results in selected patients.
(C) 1997 by The Society of Thoracic Surgeons.