Birla R, Patel P, Aresu G, Asimakopoulos G
University of Bristol, UK.
Ann R Coll Surg Engl. 2013 Oct;95(7):481-5. doi: 10.1308/003588413X13629960047119.
Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy.
Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners.
Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05).
MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.
尽管微创直接冠状动脉旁路移植术（MIDCAB）并非新技术，但在英国只有少数外科医生采用。我们将自己开展MIDCAB的经验与通过标准正中胸骨切开术进行单支血管非体外循环冠状动脉旁路移植术（OPCAB）的经验进行了比较。
对2008年4月至2011年7月期间接受MIDCAB或OPCAB手术的患者进行了回顾。排除标准包括射血分数<0.5的患者或既往有心脏手术史的患者。数据通过回顾我们的前瞻性数据库、病历并通过全科医生获得。
总体而言，MIDCAB组分析了74例患者，OPCAB组分析了78例患者。他们的人口统计学特征和欧洲心脏手术风险评估系统（EuroSCORE）值具有可比性（p>0.05）。两组在死亡率、复发性心肌梗死、术后中风、伤口感染、心房颤动或再次干预需求方面无统计学显著差异。MIDCAB组有6例转为胸骨切开术。每组有8例患者需要输血，MIDCAB组平均输血量为1.8单位，OPCAB组为3.2单位。MIDCAB组的平均通气时间和重症监护病房住院时间分别为5.0小时和38.4小时，OPCAB组分别为5.4小时和47.8小时。MIDCAB组患者的平均住院时间显著缩短（6.1天对8.5天，p<0.05）。
在适当选择的患者中，MIDCAB可以安全进行，其结果与OPCAB相当。潜在益处包括缩短住院时间、减少输血需求和更快康复。
