Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomy

被引:2
|
作者
Sellin, Christian [1 ]
Belmenai, Ahmed [1 ]
Niethammer, Margit [2 ]
Schaechinger, Volker [2 ]
Doerger, Hilmar [1 ]
机构
[1] Univ Med Marburg, Heart Thorax Ctr, Dept Cardiothorac Surg, Klinikum Fulda, Campus Fulda,Pacelliallee 4, D-36043 Fulda, Germany
[2] Univ Med Marburg, Heart Thorax Ctr, Dept Cardiol, Klinikum Fulda, Campus Fulda, Fulda, Germany
关键词
ARTERY-DISEASE; OFF-PUMP; OUTCOMES; INTERVENTION; DEFINITION; SOCIETY; STROKE; CABG;
D O I
10.1016/j.xjtc.2024.05.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. Methods: From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 +/- 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 +/- 2.8. Mean midterm follow-up (100%) was 15.2 +/- 10.7 months (range, 0.1-39.5 months). Results: Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 +/- 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. Conclusions: This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.
引用
收藏
页码:52 / 60
页数:9
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