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Minimally Invasive Approach for Anomalous Right Coronary Recover Faster than Full Sternotomy.
Barbara Robinson1, Prem Shekar2, Frederick Chen2, Ann Burgess2, James Rawn2, Lawrence H. Cohn2.
1SUNY Medical Center, Division. of Cardiothoracic Surgery, Syracuse, NY, USA, 2Harvard, Brigham and Women's Hospital, Boston, MA, USA.
OBJECTIVE: Adults with congenital heart disease(ACHD) have surpassed those with pediatric congenital heart disease(CHD). Minimally invasive surgery has expanded to ACHD but has not been previously described for anomalous coronaries(AC) in the adult. Anomalous right coronary from left coronary sinus(ARCA) undergoing reimplantation were addressed by either full sternotomy(FS) or partial upperhemisternotomy(PS). We hypothesized equipoise between PS and FS in ARCA reimplantation(ARCARI).
METHODS: Patients underwent ARCARI. PS or FS was performed. Postoperative cardiopulmonary bypass(CPB) and crossclamp times(CCT), creatinine phosphokinase myocardial band(CPKMB), intensive care(ICU) and length of stay(LOS) were determined. Values were expressed as a mean +/- standard deviation. p values <= 0.05 were considered significant.
RESULTS: Of the 27 patients, 17 underwent repair of ARCA with 8 undergoing ARCARI and of those, 3 via FS and 5 PS. Mean age of FS was 55+/-12, significantly older than 42+/-4 for PS(p=0.04). FS was performed in 1 woman and 2 men, and PS in 5 men. CPB for PS(67+/-7 min) was shorter than FS(93+/-30 min)(p=0.04). Similarly CCT for PS(33+/-9 min) was also significantly shorter than FS (60+/-20 min)(p=0.015). This resulted in CPKMB for PS of 8 and for FS 25 which trended to be significantly different(p=0.008). Likewise, mean ICU stay for PS was 1 day and 4 for FS due to one outlier(p=0.2). Mean LOS was shorter for PS at 3.6 days than 12 for FS(p=0.05). Operative mortality for the entire ARCARI group was 0%.
CONCLUSIONS: In conclusion, reimplantation of ARCA can be performed successfully through a partial upperhemisternotomy. This is the largest series in the literature of ARCA reimplantation and the first to describe ARCA reimplanted via a partial sternotomy. ARCARI unexpectedly had shorter CPB and CCT times, less CPKMB production, shorter ICU stay and total LOS than through full sternotomy. Partial upperhemisternotomy is feasible in ARCA and can be performed safely and efficiently with low morbidity and mortality.
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