Single vessel revascularization with beating heart techniques -- minithoracotomy or sternotomy?

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Coronary Artery Bypass Grafting

Background:

• Off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) are surgical techniques for coronary artery revascularization.
• The left anterior descending (LAD) artery is a common target for single-vessel bypass surgery.

Purpose of the Study:

• To compare the efficacy and safety of MIDCAB versus OPCAB for single-vessel revascularization of the LAD.
• To determine the optimal surgical approach for LAD revascularization in off-pump settings.

Main Methods:

• A comparative study involving 256 patients undergoing single left internal mammary artery (LIMA) to LAD bypass.
• Patients were divided into two groups: MIDCAB (n=129) via left anterior minithoracotomy and OPCAB (n=127) via full sternotomy, both using beating heart techniques.

Main Results:

• The OPCAB group had more severe comorbidities and redo-operations. Conversion to cardiopulmonary bypass was rare in both groups (MIDCAB: 5, OPCAB: 1).
• No cerebrovascular accidents occurred. Hospital mortality was low (MIDCAB: 0, OPCAB: 2). MIDCAB showed longer surgery and occlusion times, with higher wound infection rates.
• Graft patency rates were comparable (MIDCAB: 96%, OPCAB: 98%), with similar postoperative ventilation, ICU, and hospital stay durations.

Conclusions:

• Both MIDCAB and OPCAB demonstrate good clinical outcomes with low mortality and early complications.
• MIDCAB is technically demanding, indicated for selected patients with favorable coronary anatomy.
• Off-pump sternotomy revascularization (OPCAB) is a safe option, even for high-risk patients.