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
The Annals of Thoracic Surgery
|May 30, 2006
Summary
Anterolateral thoracotomy coronary artery bypass (ALT-CAB) offers a less invasive approach for complete myocardial revascularization. This technique is safe and feasible for most patients needing coronary artery surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Minimally invasive techniques are increasingly sought to reduce surgical trauma in coronary artery bypass grafting.
- While thoracotomy is used for reoperative and valvular surgery, its application in primary revascularization is less common.
- This study investigates the efficacy of anterolateral thoracotomy-coronary artery bypass (ALT-CAB) for complete myocardial revascularization.
Purpose of the Study:
- To evaluate the safety and feasibility of complete myocardial revascularization using the anterolateral thoracotomy-coronary artery bypass (ALT-CAB) approach.
- To assess short-term and long-term outcomes in patients undergoing ALT-CAB.
Main Methods:
- A consecutive series of 255 patients underwent complete revascularization via the ALT-CAB approach between November 2002 and July 2005.
- Patient characteristics included high rates of low ejection fraction (32.2%), previous myocardial infarction (56.9%), and multivessel disease (84.3%).
- Preoperative risk scores such as EuroSCORE (mean 3.8) and Parsonnet score (mean 7.8) were recorded.
Main Results:
- Complete revascularization was achieved in all patients with a mean of 3.3 grafts, and no conversions to cardiopulmonary bypass were required.
- Mortality was low at 1.2% (3 deaths), with high rates of early extubation (93.3%) and discharge within 48 hours (65.1%).
- Postoperative complications included stroke (0.8%), bleeding requiring reexploration (2%), perioperative myocardial infarction (0.4%), and atrial fibrillation (5.5%).
Conclusions:
- Complete revascularization on the beating heart via anterolateral thoracotomy is a safe and feasible option for the majority of patients undergoing coronary artery surgery.
- The ALT-CAB approach demonstrates favorable short-term outcomes, including low morbidity and mortality.
- Long-term follow-up showed good survival rates (97.6%) with minimal instances of new myocardial infarction or recurrent angina requiring intervention.
