PDF icon Download PDF
Thorac Cardiovasc Surg 2024; 72(06): 458-462
DOI: 10.1055/a-2260-5218
Original Cardiovascular

Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?

Shiho Naito 
1   Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Hermann Reichenspurner
1   Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Björn Sill
1   Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
› Further Information
  Permissions and Reprints All articles of this category
Preview

Abstract

Background A significant impact of surgeons' experience on outcomes of off-pump coronary artery bypass (OPCAB) has been recognized through previous large-scale studies. However, a safe, effective, and concrete OPCAB training was yet to be identified. We evaluate a safety of our OPCAB training model with single left internal mammary artery (LIMA)–left anterior descending artery (LAD) as a reasonable first step.

Methods Between January 2010 and June 2019, 180 patients with an isolated single coronary bypass of the LAD using LIMA as an in situ graft via median sternotomy fulfilled the inclusion criteria. Coronary arterial bypass under cardiopulmonary bypass (CPB), utilizing other graft material, minimal invasive direct coronary arterial bypass through left-sided thoracotomy, and multiple diseased coronary artery disease were excluded. The primary outcome is an early postoperative outcome (major adverse cardiac and cerebrovascular events [MACCEs]: myocardial infarction, coronary re-revascularization, stroke, acute renal failure, and all causes of death) between residents in training under supervision (group 1: n = 63) and experienced surgeons (group 2: n = 117). Trainees were already experienced in on-pump coronary artery bypass grafting.

Results Preoperative variables were comparable. There was no significant difference in the rate of MACCEs between the two groups including hospital mortality (p = 1.000), perioperative myocardial infarction (p = 0.246), stroke (p = 0.655), and acute renal failure (p = 0.175).

Conclusion The early postoperative outcome of off-pump LIMA to the LAD performed by trainees was comparable to those by experienced surgeons. Single LIMA-LAD was safely performed by trainees under supervision without CPB. In order to master OPCAB technique, single LAD bypass might be a reasonable first step to get into touch with the technical characteristics of this special procedure.

Keywords

off-pump coronary artery bypass - training - LIMA-LAD

Authors' Contribution

S.N. and B.S. contributed to the conception of the project. S.N. created the figure, performed the statistical analysis, interpreted the data, and wrote the text. H.R. and B.S. revised the latest version of the manuscript.




Publication History

Received: 05 September 2023

Accepted: 31 January 2024

Accepted Manuscript online:
02 February 2024

Article published online:
23 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Comments on “Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?”Thorac Cardiovasc Surg 2024; 72(06): 463-463
DOI: 10.1055/s-0044-1787842