Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Sivaraj J Govindasamy, John Carson Allen Jr, Chia Shaw Yang, Lim Yeong Phang and Su J W
National Heart Centre, Singapore
Duke-NUS Medical School, Singapore
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Heart disease incidence increases with advancing age. Patients with single vessel disease can undergo coronary bypass graft surgery (left internal mammary artery to left anterior descending coronary artery) with the approach of median sternotomy or left anterior thoracotomy. Left anterior thoracotomy approach is used in the hope of achieving a less invasive operation. A total of 53 cases of single vessel coronary artery bypass graft (CABG) surgeries (left internal mammary artery to left anterior descending coronary artery) were performed at the National Heart Centre, Singapore between October 2009 and November 2011. We performed a retrospective study on all 53 patients to compare surgical and post-surgical outcomes for single vessel CABG using two surgical approaches: median sternotomy (MS) and left anterior thoracotomy (LAT). 25 cases were performed using the left anterior thoracotomy approach and 28 cases were performed using the median sternotomy approach. Two cases (8%) were converted from left anterior thoracotomy approach to median sternotomy. The average Euroscore-2 among all cases was 1.43; left anterior thoracotomy, 1.04; and median sternotomy, 1.72. Extubation rates did not differ significantly between LAT and MS in the OT, or at 6 or 10 hours post-surgery. The longest intubation was 22 hours among MS cases and 18 among LAT cases. One MS patient was re-intubated. Preoperative creatinine >110 �?¼mol/L occurred in 25.0% of MS cases compared to 20.0% for LAT (NS); 17.9% of MS cases had higher postoperative creatinine compared to 0.0% of LAT (p=0.053). One of the MS case required Lasix infusion for acute renal failure and another required dopamine. No case in either group required dialysis. One LAT case experienced atrial fibrillation compared to three MS cases (NS). At six months post-surgery 12.0% of LAT and 21.4% of MS cases had not fully recovered (NS). 72% of LAT cases were not home by POD6 compared to 50% of MS cases (p=0.013). Of seven LAT cases, four were not discharged due to logistics or social reasons. No significant differences were found between LAT and MS for ventilation duration, ICU stay, or hospital stay. However, after adjustment for confounders, a significant difference (p=0.033) was exhibited between procedures for blood loss (ml) (MS, 333; LAT, 230). The main finding of this report is that single coronary revascularization can be performed in a significant number of patients via the thoracotomy approach, giving similar results to that of the median sternotomy approach. In our single centre study, during a minimum period follow up of one year, morbidity and mortality were comparable. In conclusion, left anterior thoracotomy approach for LIMA-LAD shortened both hospital and ICU stay. Benefits of less pain and earlier return to work cannot be understated from the left anterior thoracotomy approach.
Sivaraj J Govindasamy has completed his MBChB from MBChB at University of Glasgow, UK and MRCS at Royal College of Surgeons Edinburgh, UK. He works as Senior Resident in Department of Cardiothoracic Surgery, National Heart Centre Singapore. He is in the 4th year of Cardiothoracic Surgery Residency training program at National Heart Centre Singapore.