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OBJECTIVE: Off-pump myocardial revascularization allows improved results of coronary artery revascularization regarding mortality and neurological outcome. Total arterial multi-vessel coronary revascularization through a left-sided mini-thoracotomy is technically challenging and described only in few cases. This study presents the results of this new technique of off-pump myocardial revascularization. Using the matched-pairs analysis these results will be compared to those of patients with complete sternotomy for total arterial off-pump revascularization.
METHODS: Between September 2008 and December 2012 153 patients underwent minimally invasive multi-vessel off-pump myocardial revascularization via left sided mini-thoracotomy. In all patients the left internal mammary artery was used. Additionally, the radial artery was harvested endoscopically in all patients for the use as T-graft (group M). For every patient of group M we found a matching patient operated via a conventional sternotomy using both internal mammary arteries (group C). Intraoperative data were similar in both groups (see tab. 1). A SF-36 questionnaire was given to the patients on average of 9 months post-operatively.
RESULTS: There were no hospital- as well as 30-days-mortality, no post-operative myocardial infarction and no cerebrovascular stroke, respectively. The ventilation time (4.2±3.9h vs. 5.9±3.2h, p=0.001) and the over-all hospital stay (9.4±2.4d vs. 11.4±5.3d, p<0.001) were significantly shorter for patients of group M. In the SF-36 survey, the patients showed a significant improvement regarding physical role functioning (p=0.038) and bodily pain (p=0.010). No patient reported a myocardial infarction or a cerebro-vascular stroke within the follow-up period.
CONCLUSIONS: The minimally invasive off-pump myocardial revascularization via left mini-thoracotomy is a feasible and safe procedure. It is equivalent to conventional sternotomy. Shorter ventilation time and shorter hospital stay demonstrate a faster recovery after mini-thoracotomy. Furthermore, this minimally invasive access allows an improvement of postoperative quality of life.

Tab. 1

	Group M	Group C	p-value
Euroscore	4.5±2.5	4.1±2.3	0.146
Canadian Cardiovascular Score (CCS)	2.1±1.2	2.3±1.3	0.305
No. of distal anastomoses	2.2±0.4	2.2±0.4	0.506
Operation time [min]	184±35	181±36	0.568