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Objective: Operative revascularization through small incisions is cosmetically superior to the standard approach, but is deemed to be more challenging and hazardous regarding graft-patency and outcome. We therefore compared OPCAB of the anterior wall via partial lower sternotomy (group 1) with standard full sternotomy (group 2) with special regard to inflammatory reactions, myocardial and graft damages, and long-term outcome.
Methods: Group 1 was a consecutive series of 19 pts (13 male) and group 2 of 21 consecutive pts (14 male) with LITA-LAD or an additional diagonal branch; . Mean age was 61.7±9.6 vs. 61.4±10.9years (p=0.93). Mean number of grafts was 1.1±0.2 vs. 1.2±0.4 (p=0.26), respectively. In group 1 seven pts had dual and 9 single platelet inhibition (PI) vs. in group 2 nine pts dual and 10 pts single PI.
Results: Follow-up was 8.6± 3.4years. Length of skin incision in group 1 was 7.9±2.0cm and in group 2 20.6±4.9cm (p<0.001). Operative times were not statistically different between groups (174±32 vs.162±46min, p=0.354). One patient in group 1 had conversion to full sternotomy (intramural LAD). Blood loss, intubation time and hospital stay were not significant different between groups. Stay on ICU was shorter in group 1, but did not reach significance (29.2±16.7 vs. 55.9±63.4h; p=0.12). Postoperative CK-MB, Troponin-I and inflammation markers (leucocytes, CRP, Interleukine-6, TNFp55, TNFp75) did not differ significantly between groups. One re-thoracotomy for bleeding was necessary in each group, 2 patients in group 2 underwent restabilization of the sternum. In group 1 all grafts were patent. In group 2 one patient needed stenting of the stenosed LITA. In group I three patients and in group 2 four patients needed stenting of the CX or RCA-area for progression of CAD. Actuarial-survival of group I after 1, 5 and 9 years was 100%, 100% and 94.7%, and in group 2 95.5%, 86.9% and 72.7% (p=0.07). All patients died of non-cardiac reasons. In a visual analog scale patients rated equal with regard to satisfaction with scar (p=0.28) or quality of life (p=0.66).
Conclusions: Partial lower sternotomy is apart from cosmetically improved results or sternum stability a safe approach with excellent long term results.