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Beating heart coronary artery surgery: is sternotomy a suitable alternative to minimal invasive technique?
P Gersbach1, C Imsand, L K von Segesser
1Department of Cardiology of Lausanne University Hospital, Lausanne, Switzerland. philippe.gersbach@chuv.hospvd.ch
Insights
Off-pump sternotomy (OPCAB) coronary bypass offers more grafts and patient comfort compared to minimally invasive direct coronary artery bypass (MIDCAB). While MIDCAB has cosmetic benefits, OPCAB shows fewer complications and better mid-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
- Minimally invasive direct coronary artery bypass (MIDCAB) and off-pump sternotomy (OPCAB) are alternative surgical approaches.
- Evaluating the comparative advantages and disadvantages of these techniques is crucial for optimal patient care.
Purpose of the Study:
- To compare the perioperative and mid-term outcomes of MIDCAB and OPCAB procedures.
- To identify the respective benefits and drawbacks of each surgical technique.
- To assess complication rates and patient comfort following MIDCAB versus OPCAB.
Main Methods:
- A comparative study of 31 MIDCAB and 39 OPCAB procedures performed by a single experienced surgeon.
- Assessment of perioperative data and 3-month follow-up results.
- Statistical analysis using two-tailed chi-square or unpaired t-test (P ≤ 0.05 significance).
Main Results:
- No in-hospital deaths or permanent neurological events were observed in either group.
- OPCAB patients received more anastomoses (1.89 vs. 1.09) during shorter occlusion times (16.6 vs. 26.1 min).
- MIDCAB showed higher rates of significant early complications (7/31 vs. 0/39) and residual discomfort at 3 months (14/30 vs. 7/39).
Conclusions:
- Early complication differences may be attributed to a learning curve effect.
- OPCAB demonstrates advantages in graft implantation and patient/surgeon comfort.
- The benefits of OPCAB may outweigh the cosmetic advantages of MIDCAB, particularly regarding complication rates and patient recovery.
Objectives:
To evidence the respective advantages and drawbacks of minimal invasive-thoracotomy (MIDCAB) and off-pump sternotomy (OPCAB) coronary bypass techniques.
Methods:
The perioperative and mid-term (3 months) results of the first 31 MIDCABs and 39 OPCABs performed by a single experienced coronary surgeon (F.S.) were compared. Differences were assessed by two-tailed chi-square or unpaired t-test, and significance assumed for P-values < or =0.05.
Results:
Groups were widely comparable. There were no in-hospital deaths nor permanent neurologic events. OPCAB patients received more anastomoses (mean 1.09/patient vs. 1.89/patient, P<0.001) during a shorter coronary occlusion period (26.1+/-8 vs. 16.6+/-4.5min, P<0.001), whilst immediate extubation prevailed in MIDCABs (22/31 vs. 17/39, P<0.05). Significant complications occurred in seven MIDCABs vs. none in OPCABs (P<0.01). Other in-hospital parameters were similar. Controls at 3 months evidenced more residual discomfort among MIDCAB patients (14/30 vs. 7/39, P<0.05).
Conclusions:
Differences in early complication rates may be due to a learning effect. However, OPCAB allows us to implant more grafts and is more comfortable for both patient and surgeon. These advantages may well counterbalance the cosmetic benefits of MIDCAB procedures.