Coronary revascularization of the circumflex system: Different approaches and long-term outcome
Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However,...
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| Veröffentlicht in: | The Annals of thoracic surgery 2000-10, Vol.70 (4), p.1371-1377 |
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| container_title | The Annals of thoracic surgery |
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| creator | STAMOU, Sotiris C BAFI, Ammar S BOYCE, Steven W PFISTER, Albert J DULLUM, Mercedes K. C HILL, Peter C ZAKI, Salah GARCIA, Jorge M CORSO, Paul J |
| description | Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach.
We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG. |
| doi_str_mv | 10.1016/s0003-4975(00)01680-5 |
| format | Article |
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We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/s0003-4975(00)01680-5</identifier><identifier>PMID: 11081901</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Science</publisher><subject>Aged ; Biological and medical sciences ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease - surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Medical sciences ; Middle Aged ; Minimally Invasive Surgical Procedures ; Outcome and Process Assessment (Health Care) ; Postoperative Complications - etiology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Thoracotomy</subject><ispartof>The Annals of thoracic surgery, 2000-10, Vol.70 (4), p.1371-1377</ispartof><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1530491$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11081901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>STAMOU, Sotiris C</creatorcontrib><creatorcontrib>BAFI, Ammar S</creatorcontrib><creatorcontrib>BOYCE, Steven W</creatorcontrib><creatorcontrib>PFISTER, Albert J</creatorcontrib><creatorcontrib>DULLUM, Mercedes K. C</creatorcontrib><creatorcontrib>HILL, Peter C</creatorcontrib><creatorcontrib>ZAKI, Salah</creatorcontrib><creatorcontrib>GARCIA, Jorge M</creatorcontrib><creatorcontrib>CORSO, Paul J</creatorcontrib><title>Coronary revascularization of the circumflex system: Different approaches and long-term outcome</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach.
We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiopulmonary Bypass</subject><subject>Coronary Artery Bypass</subject><subject>Coronary Disease - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Postoperative Complications - etiology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Graft diseases</topic><topic>Surgery of the heart</topic><topic>Thoracotomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>STAMOU, Sotiris C</creatorcontrib><creatorcontrib>BAFI, Ammar S</creatorcontrib><creatorcontrib>BOYCE, Steven W</creatorcontrib><creatorcontrib>PFISTER, Albert J</creatorcontrib><creatorcontrib>DULLUM, Mercedes K. 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However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach.
We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.</abstract><cop>New York, NY</cop><pub>Elsevier Science</pub><pmid>11081901</pmid><doi>10.1016/s0003-4975(00)01680-5</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiopulmonary Bypass Coronary Artery Bypass Coronary Disease - surgery Female Follow-Up Studies Humans Male Medical sciences Middle Aged Minimally Invasive Surgical Procedures Outcome and Process Assessment (Health Care) Postoperative Complications - etiology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Thoracotomy |
| title | Coronary revascularization of the circumflex system: Different approaches and long-term outcome |
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