Salamate Saad, Bakhtiary Farhad, Bayram Ali, Sirat Sami, Doss Mirko, Ciobanu Veaceslav, Monsefi Nadejda, El-Sayed Ahmad Ali
Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany.
Division of Cardiac Surgery, Heart Centre Siegburg, 53721 Siegburg, Germany.
J Clin Med. 2024 May 28;13(11):3158. doi: 10.3390/jcm13113158.
: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy for coronary artery bypass. The aim of this study was to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump coronary artery bypass through sternotomy (OPCAB) for single-vessel disease. : From January 2017 to February 2023, 377 consecutive patients aged above 18 years undergoing off-pump bypass of the left anterior descending artery (LAD) with left internal thoracic artery underwent OPCAB. Propensity score matching was then applied. Primary endpoints were in-hospital mortality and 30-day mortality. : Prior to matching, 30-day mortality occurred in 2 (0.7%) patients in the MIDCAB group vs. 1 (1%) patient in the OPCAP group ( = 1). Transfusion of red blood cells (RBC) was required in 9.4% and 29% of patients within the MIDCAB and the OPCAB groups, respectively ( < 0.001). Median intensive care stay (ICU) was 1 [1-2] day in the MIDCAB group, vs. 2 [1-3] in the OPCAB ( < 0.001). In the matched cohort, 10% of MIDCAB patients received RBCs vs. 27.5% of OPCAB patients ( = 0.006). Median ICU stay was significantly lower in the MIDCAB group, 1 [1-2] vs. 2 [1-3] days. : MIDCAB is as safe and effective as OPCAB for single coronary artery bypass of the LAD with the LITA in select patients. It is associated with a decreased ICU stay and lower transfusion rates when compared with OPCAB.
通过左胸小切口的微创方法是冠状动脉搭桥术替代正中胸骨切开术的一种有前景的选择。本研究的目的是比较接受微创冠状动脉搭桥术（MIDCAB）与通过胸骨切开术的非体外循环冠状动脉搭桥术（OPCAB）治疗单支血管病变患者的短期结局。：2017年1月至2023年2月，377例年龄在18岁以上、接受左乳内动脉非体外循环下左前降支（LAD）搭桥术的连续患者接受了OPCAB。然后应用倾向评分匹配法。主要终点是住院死亡率和30天死亡率。：匹配前，MIDCAB组有2例（0.7%）患者发生30天死亡率，而OPCAP组有1例（1%）患者（=1）。MIDCAB组和OPCAB组分别有9.4%和29%的患者需要输注红细胞（RBC）（<0.001）。MIDCAB组的重症监护病房（ICU）中位住院时间为1[1-2]天，而OPCAB组为2[1-3]天（<0.001）。在匹配队列中，10%的MIDCAB患者接受了RBC输注，而OPCAB患者为27.5%（=0.006）。MIDCAB组的ICU中位住院时间显著更低，为1[1-2]天，而OPCAB组为2[1-3]天。：对于选择的患者，MIDCAB在使用左内乳动脉进行LAD单支冠状动脉搭桥方面与OPCAB一样安全有效。与OPCAB相比，它与ICU住院时间缩短和输血率降低相关。
