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Mini-thoracotomy Versus Median Sternotomy For Off-pump Coronary Artery Bypass Of Theleft Anterior Descending Artery
Saad Salamate1, Farhad Bakhtiary
1, Nededja Monsefi
1, Ali Bayram
2, Sami Sirat
3, Veaceslav Ciobanu
1, Ali El-Sayed Ahmad
1;
1University Hospital Bonn, Bonn, Germany,
2University Hospital Bonn, Siegburg, Germany,
3Helios Klinikum Siegburg, Siegburg, Germany
BACKGROUND: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy (MS) for coronary artery bypass. The aim of this study is to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump coronary artery bypass through sternotomy (OPCAB) for single vessel disease.
METHODS: From January 2017 to February 2023, 377 consecutive patients aged above 18 years undergoing off-pump bypass of the left anterior descending artery (LAD) with the left internal thoracic artery (LITA) were included in this study. MIDCAB was performed on 277 (73.5%) patients while 100 (26.5%) patients underwent OPCAB. A 1:1 propensity score matching was then applied resulting in two groups of 80 patients each. Primary endpoints of the study were all cause in-hospital mortality and 30-day mortality.
RESULTS: Across both groups, 100 (26.5%) patients were female and mean age was 65 ±10 years. Non- elective surgery was performed in 13.5% of patients while 61.5% had a NYHA classification of III orIV. Prior to matching, 30-day mortality occurred in 2 (0.7%) of patients withing the MIDCAB group versus 1 (1%) patient in the OPCAP group (p=1). Transfusion of red blood cells was required in 9.4% and 29% of patients within the MIDCAB and the OPCAB group, respectively (p<0.001). Median intensive care stay was 1 [1 - 2] day in the MIDCAB group, versus 2 [1 - 3] in the OPCAB (p<0.001)and median hospital stay was 6 [5 - 7] days versus 7 [6 - 9] in the MIDCAB and the OPCAB group, respectively (p<0.001). After matching, 1 (1.2%) case of in-hospital mortality and 30-day mortality in each group occurred (p=1). Red blood cell transfusion was required in 8 (10%) patients of the MIDCAB group versus 22 (27.5%) in the OPCAB group (p=0.006). Median intensive care stay was 1 [1 - 2] days in the MIDCAB group versus 2 [1 - 3] days in the OPCAB group.
CONCLUSIONS: MIDCAB is as safe and effective as OPCAB for single coronary artery bypass of the left anterior descending artery with the left internal thoracic artery in select patients. It is associated with a decreased intensive care unit stay and lower transfusion rates when compared with OPCAB after propensity score matching.
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