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ANAORTIC CORONARY BYPASS THROUGH LEFT MINITHORACOTOMY: COMPARISON BETWEEN SINGLE AND MULTIVESSEL CORONARY DISEASE
BACKGROUND
Anaortic coronary artery bypass graft (CABG) has proved to be safe and effective through sternotomy. Aim of this study was to evaluate the clinical outcome of single and multivessel CABG using an off-pump “no touch aorta” technique through a left minithoracotomy.
METHODS
From July 2008 to July 2013, 169 consecutive patients were prospectively enrolled to underwent off-pump CABG through a left minithoracotomy: 84 had a single vessel coronary artery disease and underwent minimally invasive direct coronary artery bypass (MIDCAB) using only the left internal thoracic artery (LITA), 85 had a multi-vessel coronary artery disease and underwent minimally invasive cardiac surgery - CABG (MICS-CABG) using the LITA and the right radial artery as composite Y-graft. All the patients were operated on by the same surgeon.
RESULTS
Female sex was more frequent in MIDCAB group (15.4% vs 0%; p=0.002). Age (61±10 yrs MIDCAB vs 64±9 yrs MICS-CABG; p=0.11) and body mass index (25.7±4 MIDCAB vs 25.8±4 MICS-CABG; p=0.92) were similar, ejection fraction was greater in MICS-CABG group (51.5±7.1% vs 54.4±7.5%; p=0.01). There was no conversion to sternotomy in both groups. Thirty-day mortality occurred in 1 MIDCAB patient (1.1% vs 0%; p=0.99). There was neither perioperative myocardial infarction nor neurological complication in both groups. The average number of distal anastomosis was 1 in MIDCAB and 2.4±0.4 in MICS-CABG. Reoperation for bleeding (1.1% MIDCAB vs 3.5% MICS-CABG; p=0.62), blood transfusion (21% MIDCAB vs 27% MICS-CABG; p=0.49), intensive care unit length of stay (1.5±1 days MIDCAB vs 1.5 days MICS-CABG; p=0.39) and ventilation time (14.2±34.8 hrs MIDCAB vs 15±26.7 hrs MICS-CABG; p=0.73) were similar. The incidence of postoperative atrial fibrillation was greater in MICS-CABG group (15.2% vs 31.7%; p=0.021).
CONCLUSIONS
Anaortic CABG through a minithoracotomy approach confirms its safety and efficacy. MICS-CABG and MIDCAB are both safe and feasible and associated with excellent postoperative outcome.