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


  • Calin Vicol
  • Georg Nollert
  • Helmut Mair
  • Vicky Samuel
  • Che Lim
  • Michael Tiftikidis
  • Sandra Eifert
  • Bruno Reichart




Background: Off-pump cardiac surgery is becoming an established method of surgical revascularization. However, performing anastomoses on a beating heart can be challenging, especially through small incisions. We compared our midterm results in patients with 1 vessel disease using full sternotomy (OPCAB) or a left anterior minithoracotomy (MIDCAB).

Methods: At our institution between December 1996 and December 1998, 102 patients (OPCAB, n = 45, MIDCAB, n = 57); age, 61 ± 11 years; 69% men with 1-vessel disease of the left anterior descending coronary artery (LAD) underwent off-pump myocardial revascularization through the left internal thoracic artery (LITA). In the OPCAB group 17 (37.8%) of the patients received an additional vein graft to a diagonal branch. OPCAB was generally preferred in obese or high-risk patients or patients with a long LITA-LAD distance ( > 7 cm) on an electron beam computed tomography of the chest.

Results: Operative mortality was 0. Time of surgery (169 ± 48 versus 197 ± 45 minutes) and coronary artery occlusion time (19 ± 7 versus 23 ± 6 minutes) were significantly lower (P = .004 and P = .009) in the OPCAB group. MIDCAB surgery was related to a higher incidence of occluded (4 versus 0; P = .039) or stenosed (7 versus 2; P = .06) anastomoses and necessity for immediate reintervention (9 versus 0; P = .023). During a mean follow-up period of 5.2 years, MIDCAB patients (6 MIDCAB patients versus 1 OPCAB patient) tended to need more coronary interventions and develop more recurrent angina (23 MIDCAB versus 12 OPCAB patients). Two OPCAB patients died during the follow-up period.

Conclusions: Our initial experience in beating heart surgery demonstrated that MIDCAB is technically more challenging than OPCAB. MIDCAB procedures should


Ancalmo N, Busby JR. 1997. Minimally invasive coronary artery bypass surgery: really minimal? Ann Thorac Surg 64:928-9.nArom KV, Emery RW, Flavin TF, Petersen JP. 1999. Cost-effectiveness of minimally invasive coronary artery bypass surgery. Ann Thorac Surg 68:1562-6.nBonchek LI. 2002. Off-pump coronary bypass: is it for everyone? J Thorac Cardiovasc Surg 124:431-4.nCameron A, Davis KB, Green G, Schaff HV. 1996. Coronary bypass surgery with internal thoracic artery grafts: effects on survival over a 15-year period. N Engl J Med 334:216-9.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.nCooley DA. 2000. Beating-heart surgery for coronary revascularization: is it the most important development since the introduction of the heart-lung machine? Ann Thorac Surg 70:1779-81.nDetter C, Reichenspurner H, Boehm DH, Thalhammer M, Schütz A, Reichart B. 2001. Single vessel revascularization with beating heart techniques: minithoracotomy or sternotomy? Eur J Cardiothorac Surg 19:464-70.nDrenth DJ, Winter JB, Veeger NJGM, et al. 2002. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: six month angiographic and clinical follow-up of a prospective randomized study. J Thorac Cardiovasc Surg 124:130-5.nGersbach P, Imsand C, von Segesser LK, Delabays A, Vogt P, Stumpe F. 2001. Beating heart coronary artery surgery: is sternotomy a suitable alternative to minimal invasive technique? Eur J Cardiothorac Surg 20:760-4.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 72:1528-34.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nMack MJ, Osborne JA, Shennib H. 1998. Arterial graft patency in coronary artery bypass grafting: what do we really know? Ann Thorac Surg 66:1055-9.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.nShenib H, Mack MJ, Lee AGL. 1997. A survey on minimally invasive coronary artery bypass grafting. Ann Thorac Surg 64:110-5.nStanbridge RDL, Hadjinikölaou LK. 1999. Technical adjuncts in beating heart surgery: comparision of MIDCAB to off-pump sternotomy--a meta-analysis. Eur J Cardiothorac Surg 16:S24-33.n



How to Cite

Vicol, C., Nollert, G., Mair, H., Samuel, V., Lim, C., Tiftikidis, M., Eifert, S., & Reichart, B. (2005). 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. The Heart Surgery Forum, 6(5), 341-344. https://doi.org/10.1532/hsf.958




Most read articles by the same author(s)

1 2 3 > >>