Off-pump coronary surgery through mini-incisions: is it reasonable?
OBJECTIVE
Coronary artery bypass grafting as currently performed is considered the gold standard of coronary revascularization. It also, however, is a potential source of complications, especially in patients with multiple co-morbid risk factors. To alleviate some of these downsides, cardiac surgeons designed minimally invasive procedures performed off-pump, without sternotomy, and through small incisions. The efficacy of these techniques is emerging in the literature. Our aim is to describe the new technique that we are using, and provide an objective review of the recent literature with regards to safety and related surgical outcomes.


RESULTS
Although no long-term follow-up data exist yet with respect to the specific technique described herein, current evidence suggests that both on-pump and off-pump coronary bypass grafting techniques, when done in experienced centers, provide similar rates of completeness of revascularization, long-term patency, and freedom from surgical reintervention. When applied to patients at high surgical risk, observational studies suggest a decrease in the incidence of stroke, bleeding, renal complications, and mortality with off-pump bypass grafting.


CONCLUSIONS
Cardiac surgery performed off-pump without sternotomy is a procedural extension of off-pump bypass grafting which has the potential to be as safe as conventional coronary bypass grafting. The technique could offer an advantage to the high-risk patient population, or to patients for whom return to physically demanding work must be expedient after surgery.
Lapierre
Harry
H
Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Chan
Vincent
V
Ruel
Marc
M
D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D012449:Safety; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome