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Eur J Cardiothorac Surg 2001;20:760-764
© 2001 Elsevier Science NL

Beating heart coronary artery surgery: is sternotomy a suitable alternative to minimal invasive technique?

Departments of Cardiology and of Cardiovascular Surgery of Lausanne University Hospital and of Sion Regional Hospital, Lausanne, Switzerland

Received 5 January 2001; received in revised form 18 April 2001; accepted 30 May 2001.

Corresponding author. Tel.: +41-21-3142318; fax: +41-21-3142278
e-mail: philippe.gersbach{at}chuv.hospvd.ch

Objectives: To evidence the respective advantages and drawbacks of minimal invasive-thoracotomy (MIDCAB) and off-pump sternotomy (OPCAB) coronary bypass techniques. Methods: The perioperative and mid-term (3 months) results of the first 31 MIDCABs and 39 OPCABs performed by a single experienced coronary surgeon (F.S.) were compared. Differences were assessed by two-tailed chi-square or unpaired t-test, and significance assumed for P-values 0.05. Results: Groups were widely comparable. There were no in-hospital deaths nor permanent neurologic events. OPCAB patients received more anastomoses (mean 1.09/patient vs. 1.89/patient, P<0.001) during a shorter coronary occlusion period (26.1±8 vs. 16.6±4.5 min, P<0.001), whilst immediate extubation prevailed in MIDCABs (22/31 vs. 17/39, P<0.05). Significant complications occurred in seven MIDCABs vs. none in OPCABs (P<0.01). Other in-hospital parameters were similar. Controls at 3 months evidenced more residual discomfort among MIDCAB patients (14/30 vs. 7/39, P<0.05). Conclusions: Differences in early complication rates may be due to a learning effect. However, OPCAB allows us to implant more grafts and is more comfortable for both patient and surgeon. These advantages may well counterbalance the cosmetic benefits of MIDCAB procedures.

Key Words: Coronary bypass techniques • Minimal invasive-thoracotomy • Off-pump sternotomy • Completeness of revascularization • Early and late morbidity • Residual discomfort

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