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
DOI:
https://doi.org/10.1532/HSF98.20041037Abstract
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.
References
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
