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Total coronary revascularization via left anterior thoracotomy: Comparison of early- and mid-term results with
Tuna Demirkıran1, Furkan Burak Akyol1, Tayfun Özdem1
1Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye.
Insights
Total coronary revascularization via left anterior thoracotomy (TCRAT) is a safe and effective alternative to conventional coronary artery bypass grafting (CABG). TCRAT demonstrated reduced mortality and shorter hospital stays in select patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery disease necessitates surgical intervention for revascularization.
- Conventional coronary artery bypass grafting (CABG) typically involves median sternotomy.
- Alternative minimally invasive approaches are being explored to improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT).
- To compare TCRAT with conventional CABG using median sternotomy.
- To assess key clinical outcomes and patient data between the two surgical techniques.
Main Methods:
- Retrospective analysis of 108 patients undergoing TCRAT (Group 1) and 154 patients undergoing conventional CABG (Group 2).
- Operations performed by the same surgical team between February 2021 and September 2022.
- Analysis of preoperative, operative, postoperative, and mid-term follow-up data.
Main Results:
- TCRAT group showed a significantly lower all-cause mortality rate (0.9% vs. 5.8%, p=0.037).
- Patients in the TCRAT group had significantly shorter hospitalization durations (p=0.047) and fewer erythrocyte transfusions (p=0.033).
- The TCRAT group had a lower mean preoperative EuroSCORE II (1.37±1.5 vs. 2.59±2.3, p<0.001).
Conclusions:
- Total coronary revascularization via left anterior thoracotomy (TCRAT) is a safe and viable surgical technique.
- TCRAT offers potential advantages over conventional CABG in select patient populations.
- Further research may support TCRAT as a preferred method for specific cardiac surgical candidates.
Background:
This study aimed to evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT) by comparing it to conventional coronary artery bypass grafting (CABG) with median sternotomy.
Methods:
In this retrospective study, 108 patients (95 males, 13 females; mean age: 57.1±8.8; range, 41 to 75 years) who underwent TCRAT (Group 1) and 154 patients (126 males, 28 females; mean age: 61.2±9.8; range, 31 to 79) who underwent conventional CABG (Group 2) between February 1, 2021, and September 1, 2022, were evaluated. The operations were performed by the same surgical team. Preoperative, operative, and postoperative data of patients and mid-term follow-up data were analyzed.
Results:
Mean cardiopulmonary bypass and cross-clamp times, respectively, were 167.70±68.93 and 77.03±38.18 min in Group 1 and 106.64±38.27 and 62.21±24.06 min in Group 2 (p<0.001). During the postoperative period, the all-cause mortality rate was 5.8% (n=9) in Group 2, while it was 0.9% (n=1) in Group 1; there was a statistically significant difference between the two groups (p=0.037). Nevertheless, the mean preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation) II was 2.59±2.3 in Group 2, which was significantly higher than the mean EuroSCORE II of Group 1 (1.37±1.5; p<0.001). The mean hospitalization duration for Group 2 was 6.99±3.37 days, and the mean hospitalization duration for Group 1 was 6.77±4.24 days. Duration of hospitalization was statistically significantly shorter in Group 1 (p=0.047). In addition, the mean perioperative number of erythrocyte suspension transfusions in Group 1 was 1.51±1.74, while it was 1.86±1.75 in Group 2. Significantly fewer erythrocyte suspension transfusions were performed in Group 1 (p=0.033).
Conclusion:
The findings of our study indicate that TCRAT is a safe and viable technique when performed on a select patient group compared to the conventional method.
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