title: Improved recovery after the endoscopic atraumatic coronary artery bypass procedure compared with sternotomy for off-pump bypass of the left internal thoracic artery to the left anterior descending coronary artery: a case-matched study.
abstract: OBJECTIVE
  The endoscopic atraumatic coronary artery bypass (endo-ACAB) procedure allows single-vessel coronary artery bypass grafting (CABG), avoiding sternotomy or thoracotomy. We set out to define the effect of this surgical approach on postoperative recovery, blood loss, and return to work.
  
  
  METHODS
  We performed a case-control comparison of our first 29 endo-ACAB procedures for left anterior descending coronary artery (LAD) disease against 29 control patients, who underwent off-pump beating heart CABG via sternotomy for isolated LAD disease in the same institution. Control pairs were matched for age, sex, and ventricular function.
  
  
  RESULTS
  In a matched population, endo-ACAB is associated with shorter postoperative ventilation times (6.2 hours versus 9.0 hours, P = .034) and hospital stays (5.3 nights versus 6.4 nights, P = .04), less blood loss (363.9 mL versus 570.3 mL, P = .017), and lower transfusion requirements. Endo-ACAB patients were more likely to return to employment and did so at a mean of 6.6 weeks earlier than sternotomy patients (P = .019).
  
  
  CONCLUSIONS
  Endo-ACAB for grafting of the left internal mammary artery to the LAD is associated with reduced blood loss and faster postoperative recovery. Avoiding sternotomy appears to be a significant factor in recovery after beating heart single-vessel CABG surgery.
authors.affiliation: The Royal Brompton Hospital, Sydney St, London, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: West
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: John
authors.initials: J
authors.lastname: Pepper
authors.forename: Richard
authors.initials: R
authors.lastname: Trimlett
authors.forename: John
authors.initials: J
authors.lastname: Yap
authors.forename: Anthony
authors.initials: A
authors.lastname: De Souza
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D016022:Case-Control Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003331:Coronary Vessels / Q000637:transplantation*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D020127:Recovery of Function; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome