Median Sternotomy Coronary Artery Bypass Surgery for Isolated Left Anterior Descending Disease: Outcomes from The...

This study evaluates the nationwide outcome of single-vessel left anterior descending artery (LAD) revascularization through median sternotomy in the Netherlands and to analyse the impact of the surgical technique (off-pump versus on-pump).

A retrospective multicentre cohort study was conducted, including 2592 patients who underwent isolated coronary artery bypass surgery for single-vessel LAD disease from 2013 to 2022. Data were obtained from the Netherlands Heart Registration (NHR) database. The study analysed postoperative 30 days and 1 year mortality, postoperative complications, and 5-year postoperative outcome. Propensity score matching (PSM) was used to adjust for baseline differences between the off-pump (OPCAB) and on-pump (ONCAB) groups.

In the total cohort, 30-day mortality was 0.9%, with a 1-year mortality of 1.9%. The distribution of surgical technique was stable during the study period (60% OPCAB and 40% ONCAB). After PSM, there was less need for perioperative blood transfusions with OPCAB (7.0% versus 16.5%, P < .001). There was no significant difference in 30-day mortality (0.7% versus 0.6%, P = .762) and 1-year mortality (1.5% versus 1.6%, P = .932) between OPCAB and ONCAB. The Kaplan-Meier analysis demonstrated significant difference in target vessel reintervention (TVR) in favour for ONCAB (P = .028) but no difference in survival.

Single-vessel LAD revascularization through median sternotomy in the Netherlands shows good procedural outcomes, comparable for both OPCAB and ONCAB. These data might serve as a benchmark for future studies on minimally invasive revascularization.