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Ann Thorac Surg 2006;81:2142-2146
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Multivessel Revascularization on the Beating Heart by Anterolateral Left Thoracotomy

FundaCardio Foundation, Valencia, Venezuela

Accepted for publication January 11, 2006.

^_* Address correspondence to Dr Guida, Av Bolívar Norte, Resid Pecchinenda "D", Planta Baja, Valencia, Venezuela. (Email: m120159{at}telcel.net.ve).

BACKGROUND: Off-pump coronary artery bypass is commonly performed through a full median sternotomy; however, the tendency to reduce surgical trauma has stimulated cardiac surgeons to use less invasive techniques for single-vessel disease. The use of thoracotomy for reoperative and valvular surgery has also been reported, but its application in primary revascularization is still uncommon. We report here a series of consecutive patients who underwent complete myocardial revascularization on the beating heart through anterolateral thoracotomy–coronary artery bypass (ALT-CAB).

METHODS: From November 2002 to July 2005, 255 patients (75.7% male, median age 57.9 ± 10.1 years) underwent complete revascularization using the ALT-CAB approach. Eighty-two patients (32.2%) had low ejection fraction, 145 (56.9%) previous myocardial infarct, and 215 (84.3%) multivessel disease. The mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 3.8 and the Parsonnet score was 7.8.

RESULTS: Complete revascularization was achieved in all patients (mean number of grafts 3.3 ± 1.0). There were no conversions to cardiopulmonary bypass, and 3 patients died (1.2%). Two hundred thirty-seven patients (93.3%) were extubated in the operating room, and 164 patients (65.1%) were discharged home within 48 hours after surgery. Two patients (0.8%) experienced a stroke and 5 (2%) needed reexploration for bleeding. There was 1 perioperative myocardial infarction (0.4%), and 14 patients (5.5%) experienced postoperative atrial fibrillation. Five patients (2%) required treatment as an outpatient for superficial wound infection, 11 (4.4%) for left pleural effusion, and 11 (4.4%) for transient phrenic nerve palsy, which resolved spontaneously. Follow-up (median, 14.6 ± 9.7 months) survival was 97.6%. One patient (0.4%), experienced a new myocardial infarction, 9 (3.6%) required new coronary angiography for recurrent of angina, and 3 of these (1.2%) underwent angioplasty.

CONCLUSIONS: Complete revascularization on the beating heart through an anterolateral thoracotomy is safe and feasible in the majority of patients requiring coronary artery surgery.

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