Comparison of Minimally Invasive Direct Coronary Artery Bypass and Off-Pump Coronary Artery Bypass in Single-Vessel Disease

Authors

  • Osman Eren Karpuzoglu
  • Batuhan Ozay
  • Tufan Sener
  • Naz Bige Aydin
  • Bulent Ketenci
  • Timucin Aksu
  • Hakan Gercekoglu
  • Murat Demirtas

DOI:

https://doi.org/10.1532/HSF98.20081068

Abstract

Background: Off-pump coronary surgery is an established method of less invasive cardiac surgery. We compared our early results in patents with I-vessel disease who underwent surgery with full sternotomy with off-pump coronary artery bypass (OPCAB) or a left anterior minithoracotomy with minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass.

Methods: From July 2003 to June 2006, 54 patients with single-vessel disease of the left anterior descending artery who underwent surgery performed by the same surgical team were included in this prospective study. Of these patients, 27 underwent MIDCAB through an anterolateral minithoracotomy, and 27 had OPCAB through a full sternotomy. Patients were selected for the surgical groups on the basis of general condition, anatomical aspects, type of coronary lesions, comorbidities, and patient preferences. Demographic, operative, and postoperative data were collected prospectively.

Results: Demographic data, Canadian Cardiovascular Society Classification, and comorbidities were identical for both groups. There were no cases of operative mortality, early graft insufficiency, myocardial infarction, cerebrovascular accident, or conversion to cardiopulmonary bypass in either group. Durations of mechanical ventilation and total hospital stay were shorter in the MIDCAB group, 6.8 ± 3.0 hours vs 8.3 ± 1.6 hours and 4.5 ± 0.7 days vs 5.2 ± 1.4 days (P = .03 and P = .03), respectively. Atrial fibrillation was seen in 2 patients in each group; all were returned to sinus rhythm by medical therapy.

Conclusion: Although MIDCAB grafting is a challenging technique, it may be safely performed on selected patients with low postoperative mortality and morbidity.

References

American Heart Association (AHA). 2008. Heart disease and stroke statistics: 2008 Update. Dallas, Texas: American Heart Association; 2008. Available at: http://www.americanheart.org/downloadable/heart/1200082005246HS_Stats%202008.final.pdf'>http://www.americanheart.org/downloadable/heart/1200082005246HS_Stats%202008.final.pdfnArom KV, Emery RW, Flavin TF, Petersen RJ. 1999. Cost-effectiveness of minimally invasive coronary artery bypass surgery, Ann Thorac Surg; 64:928-9.nAscione R, Lloyd CT, Underwood MJ, et al. 1999. Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study. Ann Thorac Surg; 68:2237-42.nBenetti FJ, Naselli G, Wood M, Geffner L. 1991. Direct myocardial revascularization without extracorporeal circulation: experience in 700 patients. Chest 100:312-6.nBuffalo E, Andrade JCS, Branco JNR, et al. 1990. Myocardial revascularization without extracorporeal circulation: seven-year experience in 592 cases. Eur J Cardiothorac Surg 4:504-9.nDetter C, Reichenspurner H, Boehm DH, et al. 2002. Minimally invasive direct coronary artery bypass grafting (MIDCAB) and off-pump coronary artery bypass grafting (OPCAB): two techniques for beating heart surgery. Heart Surg Forum 5:157-62.nDetter C, Reichenspurner H, Boehm DH, et al. 2001. Single vessel revascularization with beating heart techniques ± minithoracotomy or sternotomy? Eur J Cardiothorac Surg 19:464-70.nDewey TM, Mack MJ. 2007. Myocardial revascularization without cardiopulmonary bypass. In: Cohn LH, editor. Cardiac surgery in the adult. 3rd ed. New York: McGraw-Hill; 633-53.nDewey TM, Mack MJ. 2003. Myocardial revascularization without cardiopulmonary bypass. In: Edmunds LH Jr, Cohn LH, editors. Cardiac surgery in the adult. 2nd Ed. New York, NY: McGraw-Hill; 609-25.nEagle KA, Guyton RA, Davidoff R, et al. 2004. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology Web Site. Available at: http://www.acc.org/clinical/guidelines/cabg/cabg.pdf'>http://www.acc.org/clinical/guidelines/cabg/cabg.pdfnFraund S, Herrmann G, Witzke A, et al. 2005. Midterm follow-up after minimally invasive direct coronary artery bypass grafting versus percutaneous coronary intervention techniques. Ann Thorac Surg 79:1225-31.nFrost L, Mølgaard H, Christiansen EH, Hjortholm K, Paulsen PK, Thomsen PE. 1992. Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. Int J Cardiol 36:253-61.nFukui T, Takanashi S, Hosada Y, Suehiro S. 2007. Early and midterm results of off-pump coronary artery bypass grafting. Ann Thorac Surg 83:115-9.nGersbach P, Imsand C, von Segesser LK, et al. 2001. Beating heart coronary artery surgery: is sternotomy a suitable alternative to minimal invasive technique? Eur J Cardiothorac Surg 20:760-4.nGóngora E, Sundt TM III. 2007. Myocardial revascularization with cardiopulmonary bypass. In: Cohn LH, editor. Cardiac surgery in the adult. 3rd ed. New York, NY: McGraw-Hill; 599-631.nGuyton RA. 2006. Coronary artery bypass is superior to drug-eluting stents in multivessel coronary artery disease. Ann Thorac Surg 81:1949-57.nHernandez F, Cohn WE, Baribeau YR, et al. 2001. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multi-center experience. Ann Thorac Surg 72:1528-33.nHolzhey DM, Jacobs S, Mochalski M, et al. 2007. Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients. Ann Thorac Surg 83:108-14.nNg PC, Chua AN, Swanson MS, Koutlas TC, Chitwood WR, Elbeery JR. 2000. Anterior thoracotomy wound complications in minimally invasive direct coronary artery bypass. Ann Thorac Surg 69:1338-41.nPuskas JD, Williams WH, Duke PG, et al. 2003. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:797-808.nRubin DA, Nieminski KE, Reed GE, Herman MV. 1987. Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations. J Thorac Cardiovasc Surg 94:331-5.nVicol C, Nollert G, Mair H, et al. 2003. Midterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy. Heart Surg Forum 6:341-4.n

Published

2009-02-20

How to Cite

Karpuzoglu, O. E., Ozay, B., Sener, T., Aydin, N. B., Ketenci, B., Aksu, T., Gercekoglu, H., & Demirtas, M. (2009). Comparison of Minimally Invasive Direct Coronary Artery Bypass and Off-Pump Coronary Artery Bypass in Single-Vessel Disease. The Heart Surgery Forum, 12(1), E39-E43. https://doi.org/10.1532/HSF98.20081068

Issue

Section

Article