Abstract
Objective: Patients with isolated lesions of the proximal left anterior descending artery (LAD) have been demonstrated to benefit more from surgical treatment than percutaneous coronary interventions (PCI). However, with the less invasiveness of PCI, the majority of the patients have been referred for this latter procedure. We report herein on the inferior ministernotomy approach for the treatment of patients with single LAD lesions, with off-pump anastomosis of the left internal thoracic artery graft. Method: Fourteen patients, consecutively operated on using this technique with the LITA graft anastomosed to the LAD, were examined. The mean age of the patients was 56.7 ± 10.1 years. The length of the skin incision varied from 7 to 9 cm and only the distal sternum was split lengthwise. The anastomosis was facilitated with the use of an Octopus-3 stabilizer (Medtronic). Results: All patients had satisfactory postoperative outcomes, the length of postoperative hospital stay ranged from 2 to 6 days (median 3 days). No ECG changes or enzymatic rises were seen in this series. One patient was readmitted for wound infection. Conclusion: The ministernotomy approach allows safe accomplishment of off-pump LAD grafting, providing the longterm benefits of using the LITA.
Highlights
Recent studies have demonstrated that patients with isolated lesions of the proximal left anterior descending artery (LAD) achieve greater clinical benefits when submitted to surgical treatment using the left internal thoracic artery (LITA) [1,2,3]
Observational data, over the last decade, demonstrated that there is a lower incidence of cardiovascular events and greater survival when the LITA is utilized in coronary artery bypass grafting
With the reduced invasiveness of the percutaneous coronary intervention (PCI), the majority of patients with isolated injuries of the LAD have been referred for this type of procedure
Summary
Recent studies have demonstrated that patients with isolated lesions of the proximal left anterior descending artery (LAD) achieve greater clinical benefits when submitted to surgical treatment using the left internal thoracic artery (LITA) [1,2,3]. Observational data, over the last decade, demonstrated that there is a lower incidence of cardiovascular events and greater survival when the LITA is utilized in coronary artery bypass grafting. The utilization of smaller operative incisions and doing without cardiopulmonary bypasses (CPB) might minimize the invasiveness and the surgical aggression with real benefits for the patient. The objective of this work is to report on the utilization of ministernotomy as a technical approach for the treatment of patients with single injuries to the LAD, using LITA grafts without the use of CPB
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