Total arterial multi-vessel revascularization. Matched-pairs analysis of results and quality of life after antero-lateral mini-thoracotomy compared to sternotomy

Off-pump myocardial revascularization allows improved results of coronary artery revascularization regarding mortality and neurological outcome. Total arterial multi-vessel coronary revascularization through a left sided mini-thoracotomy is technically challenging and described in only few cases. This study presents the results of this new technique of off-pump myocardial revascularization. Using the matched-pairs analysis results will be compared to those of patients with complete sternotomy for total arterial off-pump revascularization.

Between September 2008 and May 2011, 142 patients underwent minimally invasive multi-vessel off-pump myocardial revascularization via left sided mini-thoracotomy. In all patients the left internal mammary artery was used. Additionally, the radial artery was harvested endoscopically in all patients for the use as T-graft (group M). For every patient of group M we found a matching patient operated via a conventional sternotomy using both internal mammary arteries (group C). Intraoperative data were similar in both groups (see tab. 1). A SF-36 questionnaire was given to the patients on average of 9 months post-operatively.

Tab.1

	Group M	Group C	p-value
Euroscore	4.6±2.6	4.1±2.3	0.127
Canadian Cardiovascular Score (CCS)	2.1±1.3	2.3±1.3	0.192
No. of distal anastomoses	2.2±0.4	2.2±0.4	0.666
Operation time [min]	185±35	182±37	0.694

There were no hospital- as well as 30-days-mortality, no post-operative myocardial infarction and no cerebrovascular stroke, respectively. The ventilation time (4.3±4.1h vs. 5.9±3.2h, p=0.001) and the over-all hospital stay (9.5±2.3d vs. 11.7±5.3d, p<0.001) were significantly shorter for patients of group M. In the SF-36 survey, the patients showed a significant improvement regarding physical role functioning (p=0.002) and emotional role functioning (p=0.039). No patient reported a myocardial infarction or a cerebro-vascular stroke within the follow-up period.

The minimally invasive off-pump myocardial revascularization via left mini-thoracotomy is a feasible and safe procedure. It is equivalent to conventional sternotomy. Shorter ventilation time and shorter hospital stay demonstrate a faster