Single vessel revascularization with beating heart techniques - minithoracotomy or sternotomy?

Objective: The purpose of the study was to evaluate the best surgical appro ach in off-pump single vessel revascularization of the left anterior descen ding coronary artery (LAD). Methods: In 256 patients a single left internal mammary artery (LIMA) to LAD bypass was performed with beating heart techn iques through a left anterior minithoracotomy (minimally invasive direct co ronary artery bypass (MIDCAB), n = 129) or a full sternotomy (off-pump coro nary artery bypass (OPCAB), n = 127). Results: In the OPCAB group, signific antly more severe comorbidities (P = 0.001) and redo-operations were noted (P < 0.001). Conversion to sternotomy or CPB was necessary in five MIDCAB p atients and one OPCAB patient. No cerebrovascular accident was seen in both groups. There was no hospital death in MIDCAB- and two deaths in OPCAB pro cedures (P = ns). There was a significant reduction in time of surgery (P = 0.028) and coronary occlusion (P = 0.009) in the OPCAB group. No differenc es in postoperative ventilation time, ICU stay and length of hospital stay were recorded between groups. Wound infections occurred in six MIDCAB patie nts (4.7%) and one OPCAB patient (0.8%). Early postoperative reoperation du e to graft failure was necessary in three patients after MIDCAB and two pat ients after OPCAB (P = ns). Confirmed by angiography, the early graft paten cy rate was 96 and 98%, respectively (P = ns). Conclusions: Both beating he art techniques showed good results with low hospital mortality, low early c omplications and comparable angiographic results. Nevertheless, MIDCAB is a challenging technique as demonstrated by the longer times of surgery and c oronary occlusion with a tendency towards a higher risk of conversion and w ould infection. Thus, this technique should only be performed in selected p atients with favourable coronary anatomy. Through a sternotomy approach, si ngle vessel revascularization can be performed safely off-pump even in high -risk patients. (C) 2001 Elsevier Science B.V. All rights reserved.