Off-Pump Coronary Artery Bypass Grafting with Mini-Sternotomy in the Treatment of Triple-Vessel Coronary Artery Disease

Abstract

We have developed off-pump coronary artery bypass approach with lower distal mini-sternotomy (TM-OPCAB) for multivessel coronary revascularization. The aim of this retrospective study is to provide evidence for the feasibility and safety of this technique in the treatment of triple-vessel diseases.Two hundred eighty-eight patients with triple-vessel coronary artery disease who underwent TM-OPCAB or standard off-pump coronary artery bypass surgery (S-OPCAB) were included in this study after propensity-score matching. We retrospectively reviewed the clinical data of all patients and compared their demographic data, intra- and perioperative details, as well as short-term and long-term outcomes.TM-OPCAB resulted in significantly shorter periods of time on ventilation (P = 0.0222), shorter postoperative in-hospital stays (P < 0.0001), and lower blood transfusion rates (P = 0.0013) than S-OPCAB. Transit-time flow measurement showed there was no significant difference in postoperative graft patency between both groups. Within the 30-day post-surgical period, no death or occurrence of stroke was observed in patients undergoing TM-OPCAB or S-OPCAB. After an average of 35 months of follow-up, Kaplan-Meier survival analysis indicated that overall survival and the percentage of patients freed from major adverse cardiac and cerebrovascular events were similar between both groups. Additionally, the rate of repeat revascularization was slightly lower in the TM-OPCAB group (1.4%) than in the S-OPCAB group (2.2%), although there was no statistical difference noted.Our findings suggest that TM-OPCAB is technically feasible and safe for use in revascularization procedures in patients with triple-vessel diseases.

Systemic Inflammatory Stress Response During Cardiac Surgery

“…To overcome the limitations of technical demands and specialized equipment, Su, et al applied easy-toperform minimally invasive bypass graft surgery on triplevessel diseases. 24) They combined the off-pump coronary artery bypass approach with lower distal mini-sternotomy for multivessel coronary revascularization (TM-OPCAB). TM-OPCAB improved the patients'periods of time on ventilation, post-operative in-hospital stays, and blood transfusion rates compared to standard off-pump coronary artery bypass surgery, which includes the conventional full-length sternotomy.…”

Additional Value of Early Repolarization Pattern in Prediction of Obstructive Coronary Artery Disease as Assessed by Coronary Angiography

“…In addition, patients with multi-vessel CAD had a greater chance of developing acute myocardial infarction and sudden cardiac death than those with singlevessel CAD, and the early detection of this patient group could be of greater importance. 22,23) Therefore, our study could have a potential interesting clinical implication, thanks to the widespread availability and low cost of ECG, to stratify patients with low or intermediate risk into those who need coronary angiography from those who do not.…”

Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: a propensity-matched study

“…The same experienced surgeon performed all surgical procedures (PXSu); the LIMA to LAD anastomosis procedures have been described previously (14). Standard procedures were followed according to established protocols (15).…”

“…The standardized postoperative management and followup procedures we used have been described previously (14). After surgery, all patients in both groups were treated with the secondary prophylactic medication if there were no contraindications.…”