Improved Recovery after the Endoscopic Atraumatic Coronary Artery Bypass Procedure Compared with Sternotomy for Off-Pump Bypass of the Left Internal Thoracic Artery to the Left Anterior Descending Coronary Artery: A Case-Matched Study
Objective: The endoscopic atraumatic coronary artery bypass (endo-ACAB) procedure allows single-vessel coronary artery bypass grafting (CABG), avoiding sternotomy or thoracotomy. We set out to define the effect of this surgical approach on postoperative recovery, blood loss, and return to work.
Methods: We performed a case-control comparison of our first 29 endo-ACAB procedures for left anterior descending coronary artery (LAD) disease against 29 control patients, who underwent off-pump beating heart CABG via sternotomy for isolated LAD disease in the same institution. Control pairs were matched for age, sex, and ventricular function.
Results: In a matched population, endo-ACAB is associated with shorter postoperative ventilation times (6.2 hours versus 9.0 hours, P = .034) and hospital stays (5.3 nights versus 6.4 nights, P = .04), less blood loss (363.9 mL versus 570.3 mL, P = .017), and lower transfusion requirements. Endo-ACAB patients were more likely to return to employment and did so at a mean of 6.6 weeks earlier than sternotomy patients (P = .019).
Conclusions: Endo-ACAB for grafting of the left internal mammary artery to the LAD is associated with reduced blood loss and faster postoperative recovery. Avoiding sternotomy appears to be a significant factor in recovery after beating heart single-vessel CABG surgery.
Bellchambers J, Harris JM, Cullinan P, Gaya H, Pepper JR. 1999. A prospective study of wound infection in coronary artery surgery. Eur J Cardiothorac Surg 15:45-50.nBucerius J, Metz S, Walther T, et al. 2002. Endoscopic internal thoracic artery dissection leads to significant reduction of pain after minimally invasive direct coronary artery bypass graft surgery. Ann Thorac Surg 73:1180-4.nLichtenberg A, Hagl C, Harringer W, Klima U, Haverich A. 2000. Effects of minimally invasive coronary artery bypass on pulmonary function and postoperative pain. Ann Thorac Surg 70:461-5.nLytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. 1985. Long term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 89:248-58.nSerruys PW, Unger F, Sousa JE, et al. 2001. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 344:1117-24.nVassiliades TA Jr. 2001. Atraumatic coronary artery bypass (ACAB): techniques and outcome. Heart Surg Forum 4:331-4.nSoS Investigators. 2002. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery Trial): a randomised controlled trial. Lancet 360:965-70.nVassiliades TA Jr. 2002. Technical aids to performing thoracoscopic robotically assisted internal mammary artery harvesting. Heart Surg Forum 5:119-24.nCisowski M, Drzewiecki J, Drzewiecka-Gerber A, et al. 2002. Primary stenting versus MIDCAB: preliminary report--comparison of two methods of revascularization in single left anterior descending coronary artery stenosis. Ann Thorac Surg 74:S1334-9.nDemmy TL, Park SB, Liebler GA, et al. 1990. Recent experience with major sternal wound complications. Ann Thorac Surg 49:458-62.nDiegeler A, Falk V, Krahling M, et al. 1998. Less-invasive coronary artery bypass grafting: different techniques and approaches. Eur J Cardiothorac Surg 14(suppl 1):S13-9.nDiegeler A, Matin M, Falk V, et al. 1999. Quality assessment in minimally invasive coronary artery bypass grafting. Eur J Cardiothorac Surg 16(suppl 2):S67-72.nDiegeler A, Thiele H, Falk V, et al. 2002. Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery. N Engl J Med 347:561-6.nFitzGibbon G, Leach AJ, Keon WJ, Burton JR, Kafka HP. 1986. Coronary bypass graft fate: angiographic study of 1,179 vein grafts early, one year, and five years after operation. J Thorac Cardiovasc Surg 91:773-8.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).