Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-01 Epub Date: 2024-02-02 DOI:10.1055/a-2260-5218
Shiho Naito, Hermann Reichenspurner, Björn Sill
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引用次数: 0

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.

单个 LIMA-LAD 分流术适合用于 OPCAB 培训吗?
背景:通过之前的大规模研究,人们已经认识到外科医生的经验对体外循环冠状动脉搭桥术(OPCAB)的结果有重要影响。然而,安全、有效和具体的 OPCAB 培训尚未确定。作为合理的第一步,我们评估了单条 LIMA-LAD OPCAB 培训模式的安全性:方法:2010 年 1 月至 2019 年 6 月间,180 例经胸骨正中切口使用 LIMA 作为原位移植的 LAD 孤立单支冠状动脉搭桥术患者符合纳入标准。心肺旁路下冠状动脉搭桥术、使用其他移植物材料、通过左侧胸廓切开术进行微创直接冠状动脉搭桥术、多支冠状动脉病变等均不在纳入之列。主要结果是在指导下接受培训的住院医师(第一组:63 人)和经验丰富的外科医生(第二组:117 人)之间的术后早期结果(MACCE:心肌梗死、冠状动脉再通、中风、急性肾功能衰竭和所有死亡原因)。受训者在体外循环冠状动脉旁路移植术方面经验丰富:结果:术前变量具有可比性。结果:术前变量具有可比性,两组间的 MACCE 事件发生率无明显差异,包括住院死亡率(P=1.000)、围术期心肌梗死(P=0.246)、中风(P=0.655)和急性肾功能衰竭(P=0.175):结论:由受训者实施的LIMA-LAD泵术后早期疗效与经验丰富的外科医生相当。在没有心肺旁路的情况下,受训者可在监护下安全地进行单次LIMA-LAD手术。为了掌握 OPCAB 技术,单一 LAD 旁路可能是了解这种特殊手术技术特点的合理的第一步。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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