Beating heart coronary artery surgery: is sternotomy a suitable alternative to minimal invasive technique?
OBJECTIVE
To evidence the respective advantages and drawbacks of minimal invasive-thoracotomy (MIDCAB) and off-pump sternotomy (OPCAB) coronary bypass techniques.


METHODS
The perioperative and mid-term (3 months) results of the first 31 MIDCABs and 39 OPCABs performed by a single experienced coronary surgeon (F.S.) were compared. Differences were assessed by two-tailed chi-square or unpaired t-test, and significance assumed for P-values < or =0.05.


RESULTS
Groups were widely comparable. There were no in-hospital deaths nor permanent neurologic events. OPCAB patients received more anastomoses (mean 1.09/patient vs. 1.89/patient, P<0.001) during a shorter coronary occlusion period (26.1+/-8 vs. 16.6+/-4.5min, P<0.001), whilst immediate extubation prevailed in MIDCABs (22/31 vs. 17/39, P<0.05). Significant complications occurred in seven MIDCABs vs. none in OPCABs (P<0.01). Other in-hospital parameters were similar. Controls at 3 months evidenced more residual discomfort among MIDCAB patients (14/30 vs. 7/39, P<0.05).


CONCLUSIONS
Differences in early complication rates may be due to a learning effect. However, OPCAB allows us to implant more grafts and is more comfortable for both patient and surgeon. These advantages may well counterbalance the cosmetic benefits of MIDCAB procedures.
Gersbach
P
P
Department of Cardiology of Lausanne University Hospital, Lausanne, Switzerland. philippe.gersbach@chuv.hospvd.ch
Imsand
C
C
von Segesser
L K
LK
Delabays
A
A
Vogt
P
P
Stumpe
F
F
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy