[Clinical impact of partial sternotomy for off-pump coronary artery bypass].
History of cardiopulmonary bypass has been the pursuit for less invasiveness. Currently, about 60% of primary coronary artery bypass grafting is performed as off-pump coronary artery bypass (OPCAB). We tried to determine whether OPCAB by the lower partial sternotomy could be safely performed in the elderly patients with the age equal to or over 80 years. The number of grafts was 2.4 +/- 0.8 in patients with partial sternotomy (PS) and 2.3 +/- 0.9 in patients with full sternotomy (FS). Postoperative duration of mechanical ventilation in patients with PS was significantly shorter than that in patients with FS (p <0.05). Although the differences were not significant, the incidence of wound and respiratory complications were less in patients with PS than in those with FS. Theoretically, tracheostomy and percutaneous cricothyroidotomy can be safely performed in the early postoperative period after PS. Early ambulation can decrease the complications related to prolonged bed rest. Because dislocation of the sternoclavicular joint and/or brachial plexus injury do not occur, upper extremity movement remains unrestricted and shoulder pain does not occur. Our results suggested that OPCAB using PS could become the standard procedure in the elderly patients with multiple risk factors.
Yoshida
Shigehiko
S
Department of Cardiovascular Surgery, Shinkatsushika Hospital, Tokyo, Japan.
D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D006801:Humans; D013249:Sternum / Q000601:surgery*