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Is median sternotomy invasive? A comparison between minimally invasive direct coronary artery bypass and off-pump
N Hirata1, Y Sawa, T Takahashi
1First Department of Surgery, Osaka University Medical School, Japan.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) appears less invasive than off-pump bypass surgery. This difference may stem from MIDCAB avoiding median sternotomy, a factor potentially increasing invasiveness in off-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Surgical Outcomes
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) has limited indications.
- Off-pump bypass surgery allows complete revascularization via median sternotomy, even for multivessel disease.
Purpose of the Study:
- To compare the invasiveness of median sternotomy in MIDCAB versus off-pump bypass surgery.
- To evaluate patient recovery markers between the two surgical approaches.
Main Methods:
- Comparative study of 11 MIDCAB patients and 5 off-pump bypass patients.
- Analysis of operative time, graft number, cardiac enzyme levels (CK, CK-MB), blood loss, C-reactive protein, and hospital stay.
Main Results:
- No significant differences in age, operative time, grafts, CK, CK-MB, or blood loss.
- Shorter inflammatory marker normalization period (7 vs. 15 days, P<0.01) in MIDCAB group.
- Similar hospital stays (16 vs. 26 days) between groups.
Conclusions:
- Off-pump bypass surgery may be more invasive than MIDCAB.
- Median sternotomy, used in off-pump bypass, is a likely contributor to increased invasiveness.
Abstract:
Although minimally invasive direct coronary artery bypass (MIDCAB) eliminates the need for median sternotomy and cardiopulmonary bypass, its indications are limited. Conversely, coronary artery bypass without cardiopulmonary bypass (off-pump bypass) enables complete surgical revascularization under an optimal surgical field established by median sternotomy, even if patients have multivessel disease. The present study was designed to determine the invasiveness of median sternotomy by comparing 11 patients who underwent MIDCAB and 5 who underwent off-pump bypass between May 1997 and April 1998. There were no significant differences between the MIDCAB group and the off-pump group in age, being 57 +/- 11 vs 66 +/- 8 years old, the operative time, being 321 +/- 149 vs 441 +/- 205 min, the number of grafts, being 1.0 vs 1.4/patient, peak creatine kinase (CK) values, being 662 +/- 436 vs 609 +/- 56 IU/l, the peak CK-muscle-brain values, being 12 +/- 9 vs 16 +/- 5 IU/l, and the postoperative blood loss, being 369 +/- 198 vs 541 +/- 204 ml. Although there was no significant difference in peak C-reactive protein, at 17 +/- 5 vs 20 +/- 2 mg/dl, the periods declining within the normal ranges were shorter in the MIDCAB group than in the off-pump group, at 7 +/- 1 vs 15 +/- 2 days (P > 0.01). The hospital stay was almost the same in both groups, at 16 +/- 8 vs 26 +/- 14 days. These findings suggest that off-pump bypass is more invasive than MIDCAB, which may be attributed to the median sternotomy.