Advantages of an Inverted J-Shaped Partial Sternotomy in Off-Pump Revascularization of the Left Anterior Descending Coronary Artery
Background: In this study, we compared the clinical outcomes of two different surgical approach, full length median sternotomy (FLMS) versus inverted J shaped partial sternotomy (IJPS), in the off-pump revascularization of the left anterior descending (LAD) coronary artery. Methods: Between January 2008 and January 2011, the data from 119 patients (79 males, 40 females; mean age 61.6 ± 10.7 years) who were operated for off-pump surgical revascularization of the LAD I-vessel LAD coronary artery were retrospectively analyzed. The patients were divided into two groups as retrospective and non-randomized. including IJPS and FLMS. There were 46 patients (23 males, 23 females) in the IJPS group and 73 patients (56 males, 17 females) in the FLMS group. Preoperative, perioperative and early postoperative data of both groups were compared retrospectively.
Results: Demographic characteristics were similar for both groups. There was no mortality, early graft insufficiency or myocardial infarction in either group. There was no need for conversion to FLMS in the IJPS group. The duration of mechanical ventilation was shorter in the IJPS group (209.67 ± 109.7 min versus 429.45 ± 267.3 min, p < 0.001). The length of intensive care unit (ICU) stay was also shorter in the UPS group (20.33 ± 1.78 hours versus 22.85 ± 14.46 hours. p > 0.05). There was no difference in operation time between the groups. The postoperative amount of bleeding (453 ± 87 ml in the FLMS group versus 418 ± 72 ml in the IJPS, p < 0.05) and blood and blood product usage (2.23 ± 1.23 unit versus 1.63 ± 1.21 unit, respectively in the FLMS and the UPS group, p < 0.05) were higher in the FLMS group. The length of hospital stay was shorter in the IJPS group (5.69 ± 0.5 days versus 7.13 ± 2.7 days. p > 0.05), however there was no statistically significant difference between the groups. There was only one sternum detachment in the FLMS group (1.26%). No sternal dehiscence was observed in the IJPS group. Surgical site infection was seen in one patient in the UPS group (3.3%) and in four patients in the FLMS group (%5).
Conclusion: Inverted J partial sternotomy is a technically safe and an effective approach with excellent cosmetic outcomes in the revascularization of the LAD coronary artery. Inverted J partial sternotomy is an optimal alternative minimal invasive surgical technique in the revascularization of the LAD coronary artery.
T. Sener et al., "Advantages of an Inverted J-Shaped Partial Sternotomy in Off-Pump Revascularization of the Left Anterior Descending Coronary Artery," Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery, vol. 20, no. 4, pp. 749-754, Oct 2012.
The definitive version is available at http://dx.doi.org/10.5606/tgkdc.dergisi.2012.149
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