title: 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.
abstract: 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 therefore be performed by experienced surgeons on selected patients. Midterm results after OPCAB procedures tend to a lower rate of adverse cardiac events.
authors.affiliation: Department of Cardiac Surgery of the Ludwig-Maximilian University Munich, Grosshadern Medical Center, Munich, Germany. cvicol@belios.med.uni-muenchen.de
authors.forename: Calin
authors.initials: C
authors.lastname: Vicol
authors.forename: Georg
authors.initials: G
authors.lastname: Nollert
authors.forename: Helmut
authors.initials: H
authors.lastname: Mair
authors.forename: Vicky
authors.initials: V
authors.lastname: Samuel
authors.forename: Che
authors.initials: C
authors.lastname: Lim
authors.forename: Michael
authors.initials: M
authors.lastname: Tiftikidis
authors.forename: Sandra
authors.initials: S
authors.lastname: Eifert
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: D000704:Analysis of Variance; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013223:Statistics as Topic; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors