title: Coronary revascularization of the circumflex system: different approaches and long-term outcome.
abstract: BACKGROUND
  Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach.
  
  
  METHODS
  We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
  
  
  RESULTS
  Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
  
  
  CONCLUSIONS
  Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.
authors.affiliation: Department of Surgery, Washington Hospital Center, and MedStar Research Institute, Washington, DC 20010, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Stamou
authors.forename: A S
authors.initials: AS
authors.lastname: Bafi
authors.forename: S W
authors.initials: SW
authors.lastname: Boyce
authors.forename: A J
authors.initials: AJ
authors.lastname: Pfister
authors.forename: M K
authors.initials: MK
authors.lastname: Dullum
authors.forename: P C
authors.initials: PC
authors.lastname: Hill
authors.forename: S
authors.initials: S
authors.lastname: Zaki
authors.forename: J M
authors.initials: JM
authors.lastname: Garcia
authors.forename: P J
authors.initials: PJ
authors.lastname: Corso
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D013908:Thoracotomy