Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-Up

Background The aim of this retrospective study was to evaluate the safety and efficacy of left anterior small thoracotomy for treatment of isolated chronic total occlusion of the left anterior descending artery. Methods From November 21, 1994, to December 31, 2002, 143 patients with isolated left anterior descending artery chronic occlusion underwent off-pump surgery through left anterior small thoracotomy. Safety was evaluated analyzing 30-day mortality, major adverse cardiac events, and major complications; efficacy was evaluated analyzing 6-month angiographic results and 12-month survival, freedom from cardiac death, freedom from acute myocardial infarction, either in all areas or in the grafted one, freedom from redo or percutaneous coronary intervention, freedom from target vessel revascularization, and freedom from major adverse cardiac events and from any event. Eight-year outcome was reported as well. Results Thirty-day mortality was 0.7% (1 patient). No patient experienced acute myocardial infarction, cerebrovascular accident, or urgent repeat revascularization. One-year survival was 98.6% ± 0.7%; freedom from cardiac death was 99.3% ± 0.7%; freedom from acute myocardial infarction in either all areas or in the grafted one was 100%; freedom from redo or percutaneous coronary intervention or from target vessel revascularization was 99.3% ± 0.7%, and freedom from major adverse cardiac events or any event was 97.9% ± 1.2%. Eight-year survival was 94.9% ± 1.9%; freedom from cardiac death was 96.3% ± 1.6%, from acute myocardial infarction in all or in the grafted area 99.2% ± 0.8%, from redo or percutaneous coronary intervention 94.4% ± 2.1, from target vessel revascularization 97.8% ± 1.3%, from major adverse cardiac events 92.8% ± 2.2%, and from any event 89.5% ± 2.7%. Six months after surgery, 56% of survivors underwent angiographic control, showing a patency rate of 98.2%. Conclusions In our experience, left anterior small thoracotomy operation can be considered a suitable choice for treatment of left anterior descending artery chronic occlusion.