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J Thorac Cardiovasc Surg 1998;115:763-771
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Sponsor: Tomas A. Salerno, MD
Department of Cardiac Surgery, University "G. D'Annunzio" of Chieti, Italy, and Division of Cardiology, Pescara, Italy.
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 13, 1997. Revisions requested July 3, 1997; revisions received Nov. 18, 1997. Accepted for publication Nov. 20, 1997. Address for reprints: Antonio Maria Calafiore, MD, Department ofCardiac Surgery, "San Camillo de" Lellis" Hospital, Via Forlanini50, 66100 Chieti, Italy.
Abstract
Background: Our experience with a left internal thoracic artery graft to the left anterior descending artery via a left anterior small thoracotomy is reviewed to evaluate midterm results.
Methods: From November 1994 to April 1997, four hundred sixty patients were scheduled to undergo a left internal thoracic artery graft to the left anterior descending coronary artery via a left anterior small thoracotomy; 26 of these patients (5.7%) were converted and 434 of them had the operation. Two hundred fourteen patients (49.3%) had isolated disease of the left anterior 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: Three hundred nine patients (71.2%) underwent extubation by hour 2. Mean intensive care unit stay was 4.2 ± 4.5 hours; mean postoperative hospital 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 (
30 days), and eight patients underwent reoperation late (>30 days) because of conduit/anastomotic malfunction. Four patients underwent reoperation with patent anastomosis for progression of disease (n = 3) or pericarditis (n = 1). Three patients had a percutaneous transluminal coronary angioplasty. Cumulating angiographic and stress Doppler flow assessment results, a patent anastomosis was obtained in 417 patients and a nonrestrictive anastomosis in 404 patients. 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 patients, with our increased experience and better instruments, we obtained a patent anastomosis in 188 patients (98.9%) and a nonrestrictive anastomosis in 185 (97.4%).
Conclusions: Left anterior small thoracotomy gives acceptable midterm results. Incidence of patent and nonrestrictive anastomoses was satisfactory, especially in the most recent part of our experience, when the learning curve ended.
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