Multivessel revascularization on the beating heart by anterolateral left thoracotomy
Máximo C Guida1, Giuseppina Pecora, Alvaro Bacalao
1FundaCardio Foundation, Valencia, Venezuela. m120159@telcel.net.ve
Background:
Off-pump coronary artery bypass is commonly performed through a full median sternotomy; however, the tendency to reduce surgical trauma has stimulated cardiac surgeons to use less invasive techniques for single-vessel disease. The use of thoracotomy for reoperative and valvular surgery has also been reported, but its application in primary revascularization is still uncommon. We report here a series of consecutive patients who underwent complete myocardial revascularization on the beating heart through anterolateral thoracotomy-coronary artery bypass (ALT-CAB).
Methods:
From November 2002 to July 2005, 255 patients (75.7% male, median age 57.9 +/- 10.1 years) underwent complete revascularization using the ALT-CAB approach. Eighty-two patients (32.2%) had low ejection fraction, 145 (56.9%) previous myocardial infarct, and 215 (84.3%) multivessel disease. The mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 3.8 and the Parsonnet score was 7.8.
Results:
Complete revascularization was achieved in all patients (mean number of grafts 3.3 +/- 1.0). There were no conversions to cardiopulmonary bypass, and 3 patients died (1.2%). Two hundred thirty-seven patients (93.3%) were extubated in the operating room, and 164 patients (65.1%) were discharged home within 48 hours after surgery. Two patients (0.8%) experienced a stroke and 5 (2%) needed reexploration for bleeding. There was 1 perioperative myocardial infarction (0.4%), and 14 patients (5.5%) experienced postoperative atrial fibrillation. Five patients (2%) required treatment as an outpatient for superficial wound infection, 11 (4.4%) for left pleural effusion, and 11 (4.4%) for transient phrenic nerve palsy, which resolved spontaneously. Follow-up (median, 14.6 +/- 9.7 months) survival was 97.6%. One patient (0.4%), experienced a new myocardial infarction, 9 (3.6%) required new coronary angiography for recurrent of angina, and 3 of these (1.2%) underwent angioplasty.
Conclusions:
Complete revascularization on the beating heart through an anterolateral thoracotomy is safe and feasible in the majority of patients requiring coronary artery surgery.
