The use of "LAST" operation in high risk patient L'uso dell'intervento "LAST" nei pazienti ad alto rischio

The use of "LAST" operation in high risk patient. G. Ismeno, A. Falco, F.P. Tritto, A. d'Angelo, F. Longobardi, G. Damiani, J. Marmo, R. Gregorio, L. Piazza. Background: The LAST operation, in spite of few draw- backs, represents a good option for single Left Anterior De- scending (LAD) revascularization. This procedure does not al- low multivessel revascularization, where hybrid procedure have been previous described. We report preliminary experi- ence with the LAST operation performed in high risk patients. Matherial and Methods: From October 2004 to Febru- ary 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% re- spectively. 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 myocar- dial revascularization. An incision of about 6 cm was made in the appropriate intercostal space and the LIMA (Left In- ternal 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. Fol- lowing the insertion of a temporary intracoronary shunt, the LIMA was LAD anastomosis was carried out with a contin- uous 8-0 polypropylene suture. Results: No hospital or late mortality was observed. Un- eventful 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 pa- tients who need coronary revascularization.