Total coronary revascularization via left anterior thoracotomy: Comparison of early- and mid-term results with conventional surgery

Background: This study aimed to evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT) by comparing it to conventional coronary artery bypass grafting (CABG) with median sternotomy. Methods: In this retrospective study, 108 patients (95 males, 13 females; mean age: 57.1 +/- 8.8; range, 41 to 75 years) who underwent TCRAT (Group 1) and 154 patients (126 males, 28 females; mean age: 61.2 +/- 9.8; range, 31 to 79) who underwent conventional CABG (Group 2) between February 1, 2021, and September 1, 2022, were evaluated. The operations were performed by the same surgical team. Preoperative, operative, and postoperative data of patients and mid-term follow-up data were analyzed. Results: Mean cardiopulmonary bypass and cross-clamp times, respectively, were 167.70 +/- 68.93 and 77.03 +/- 38.18 min in Group 1 and 106.64 +/- 38.27 and 62.21 +/- 24.06 min in Group 2 (p<0.001). During the postoperative period, the all-cause mortality rate was 5.8% (n=9) in Group 2, while it was 0.9% (n=1) in Group 1; there was a statistically significant difference between the two groups (p=0.037). Nevertheless, the mean preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation) II was 2.59 +/- 2.3 in Group 2, which was significantly higher than the mean EuroSCORE II of Group 1 (1.37 +/- 1.5; p<0.001). The mean hospitalization duration for Group 2 was 6.99 +/- 3.37 days, and the mean hospitalization duration for Group 1 was 6.77 +/- 4.24 days. Duration of hospitalization was statistically significantly shorter in Group 1 (p=0.047). In addition, the mean perioperative number of erythrocyte suspension transfusions in Group 1 was 1.51 +/- 1.74, while it was 1.86 +/- 1.75 in Group 2. Significantly fewer erythrocyte suspension transfusions were performed in Group 1 (p=0.033). Conclusion: The findings of our study indicate that TCRAT is a safe and viable technique when performed on a select patient group compared to the conventional method.