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Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?

Shiho Naito1, Hermann Reichenspurner1, Björn Sill1

  • 1Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

The Thoracic and Cardiovascular Surgeon
|February 2, 2024
PubMed
Summary
This summary is machine-generated.

Off-pump coronary artery bypass (OPCAB) training using a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) demonstrated comparable early postoperative outcomes between trainees and experienced surgeons. This suggests single LIMA-LAD bypass is a safe initial step for OPCAB training.

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Area of Science:

  • Cardiovascular Surgery
  • Surgical Education
  • Minimally Invasive Cardiac Surgery

Background:

  • Surgeon experience significantly impacts off-pump coronary artery bypass (OPCAB) outcomes.
  • A standardized OPCAB training model is needed.
  • This study evaluates the safety of a specific OPCAB training model using single left internal mammary artery (LIMA) to the left anterior descending artery (LAD).

Purpose of the Study:

  • To assess the safety and efficacy of a training model for off-pump coronary artery bypass (OPCAB) surgery.
  • To compare early postoperative outcomes of OPCAB procedures performed by surgical trainees versus experienced surgeons.
  • To determine if single LIMA-LAD bypass is a suitable introductory procedure for OPCAB training.

Main Methods:

  • A retrospective study of 180 patients undergoing isolated single LIMA-LAD bypass between January 2010 and June 2019.
  • Exclusion criteria included on-pump coronary artery bypass, other graft materials, minimally invasive approaches, and multi-vessel disease.
  • Comparison of major adverse cardiac and cerebrovascular events (MACCEs) between trainees (n=63) and experienced surgeons (n=117).

Main Results:

  • No significant difference in MACCEs between trainee and experienced surgeon groups.
  • Specific outcomes including hospital mortality, perioperative myocardial infarction, stroke, and acute renal failure were comparable.
  • Preoperative variables were also similar between the two groups.

Conclusions:

  • Early postoperative outcomes for off-pump LIMA-LAD bypass performed by trainees under supervision are comparable to those by experienced surgeons.
  • Single LIMA-LAD bypass can be safely performed by trainees without cardiopulmonary bypass.
  • This procedure serves as a reasonable foundational step for mastering OPCAB techniques.