The use of “LAST†operation in high risk patient

https://doi.org/10.4081/monaldi.2006.535

Authors

  • Gennaro Ismeno | gennaroismeno@yahoo.com Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Antonio Falco Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Francesco Paolo Tritto Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Antonio d’Angelo Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Francesco Longobardi Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Girolamo Damiani Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Joseph Marmo Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Rosario Gregorio Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.
  • Luigi Piazza Division of Cardiac Surgery, San Sebastiano Hospital, Caserta, Italy.

Abstract

Background: The LAST operation, in spite of few drawbacks, represents a good option for single Left Anterior Descending (LAD) revascularization. This procedure does not allow multivessel revascularization, where hybrid procedure have been previous described. We report preliminary experience with the LAST operation performed in high risk patients. Matherial and Methods: From October 2004 to February 2005, 11 male high risk patients (mean age 74±8 years) underwent the LAST operation. Mean predicted death with EUROSCORE and Parsonnet score were 29% and 31% respectively. All patients had a proximal LAD lesion either not suitable for PTCA and multivessel coronary artery disease. The mean preoperative Ejection Fraction was 42±5% (27- 55%). Four patients (36.4%) had previous surgical myocardial revascularization. An incision of about 6 cm was made in the appropriate intercostal space and the LIMA (Left Internal Mammary Artery) was harvested using a special costal retractor. After heparin administration the LIMA is distally divided to check the adequacy of the blood flow. Following the insertion of a temporary intracoronary shunt, the LIMA was LAD anastomosis was carried out with a continuous 8-0 polypropylene suture. Results: No hospital or late mortality was observed. Uneventful conversion to midline sternotomy was necessary in one patient with low value of mammary flow. All patients were discharged within the first postoperative week. Conclusions: The use of the LAST operation enhances the role of minimally invasive surgery also in high risk patients who need coronary revascularization.

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Published
2016-02-05
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How to Cite
Ismeno, Gennaro, Antonio Falco, Francesco Paolo Tritto, Antonio d’Angelo, Francesco Longobardi, Girolamo Damiani, Joseph Marmo, Rosario Gregorio, and Luigi Piazza. 2016. “The Use of “LAST” Operation in High Risk Patient”. Monaldi Archives for Chest Disease 66 (1). https://doi.org/10.4081/monaldi.2006.535.

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