Tekin Ali İhsan, Arslan Ümit
Cardiovascular Surgery Department, Kayseri Education and Training Hospital, Kayseri, Turkey.
Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2017 Sep;12(3):285-290. doi: 10.5114/wiitm.2017.67679. Epub 2017 May 12.
Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB).
To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery.
Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses.
Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group.
We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.
孤立性左前降支冠状动脉疾病的外科治疗可通过左前外侧开胸的微创直接冠状动脉搭桥术（MIDCAB）或正中开胸的非体外循环冠状动脉搭桥术（OPCAB）进行。
比较接受MIDCAB或OPCAB手术患者的围手术期结局。
对2013年10月至2015年12月期间因孤立性左前降支（LAD）冠状动脉疾病接受MIDCAB或OPCAB手术的患者进行回顾性评估。手术由同一手术团队进行。记录患者术前、术中和术后数据进行分析。
23例患者（7例女性，16例男性）接受了MIDCAB手术，24例患者（4例女性，20例男性）接受了OPCAB手术。两组患者术前特征具有可比性。MIDCAB组机械通气时间（5.1±0.7小时对6.6±0.9小时）、重症监护病房停留时间（19.4±2.5小时对45.8±5.4小时）和住院时间（4.3±0.4天对5.6±0.8天）明显更短（p<0.01）。OPCAB组患者需要更多的输血（1.83±0.38单位对0.17±0.38单位）和新鲜冰冻血浆使用量（2.33±0.96单位对0.69±0.76单位）（p<0.01）。MIDCAB组无需转为开胸手术。两组均无死亡、转为体外循环或严重并发症发生。
我们认为，在治疗严重LAD病变患者时，MIDCAB技术比OPCAB技术更具优势。
