title: Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease.
abstract: BACKGROUND
  Single-vessel disease of the left anterior descending (LAD) coronary artery may be surgically revascularized by left internal mammary artery (LIMA) grafting either through a sternotomy or a nonsternotomy approach. Nonsternotomy approaches are used in the hope of achieving a less invasive operation. It is unknown whether nonsternotomy approaches impact in-hospital or midterm outcomes.
  
  
  METHODS
  The institutional Society of Thoracic Surgeons (STS) database at a single US academic center was reviewed for 597 consecutive patients treated surgically for single-vessel LAD disease from January 1, 2002 to June 30, 2011. In-hospital adverse events and length of stay (LOS) were compared between patients who had LIMA-LAD grafting performed through a sternotomy (sternotomy patients) versus patients who had this procedure performed through a nonsternotomy approach (nonsternotomy patients), adjusted for propensity score (likelihood of receiving sternotomy, calculated on 33 variables). Midterm survival between groups was compared using Kaplan-Meier and Cox regression analysis by referencing the National Social Security Death Index.
  
  
  RESULTS
  There were 597 consecutive patients who underwent single-vessel grafting by LIMA-LAD coronary artery grafting. Of these patients, 234 underwent sternotomy, whereas 363 patients had nonsternotomy procedures: 239 patients had endoscopic LIMA harvest and left anterolateral thoracotomy, 106 patients had robot LIMA harvest and left anterolateral thoracotomy, and 18 patients had minimally invasive direct coronary artery bypass. There were no strokes in the nonsternotomy group and 3 (1.3%) in the sternotomy group (p = 0.031). Thirty-day mortality, incidence of myocardial infarction, hospital LOS, and midterm survival were similar between groups. Operative time was significantly longer in the nonsternotomy group (1.8 hours, 95% confidence interval [CI], 1.5-2.1).
  
  
  CONCLUSIONS
  In this propensity-adjusted comparison, sternal-sparing incisions were associated with similar 30-day adverse events and midterm survival compared with sternotomy for single-vessel LIMA-LAD artery grafting.
authors: Clinical Research Unit, Division of Cardiothoracic Surgery, School of Medicine, Emory University, Atlanta, Georgia 30308, USA. mhalkos@emory.edu
authors: Michael E
authors: ME
authors: Halkos
authors: Thomas A
authors: TA
authors: Vassiliades
authors: Richard J
authors: RJ
authors: Myung
authors: Patrick
authors: P
authors: Kilgo
authors: Vinod H
authors: VH
authors: Thourani
authors: William A
authors: WA
authors: Cooper
authors: Robert A
authors: RA
authors: Guyton
authors: Omar M
authors: OM
authors: Lattouf
authors: John D
authors: JD
authors: Puskas
mesh_terms: D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy