308. Sternum sparing multi-vessel coronary surgery: in-hospital and midterm results of total coronary revascularization via left anterior thoracotomy (TCRAT)

Objective:
A sternum sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated promising early outcome in coronary artery multi-vessel disease patients. However, follow-up data are still lacking. In-hospital and midterm results after coronary bypass grafting (CABG) in unselected patients with the TCRAT-technique were investigated.
Methods:
From 11/2019 to 9/2023, CABG via left anterior minithoracotomy on cardiopulmonary bypass (peripheral cannulation) and cardioplegic cardiac arrest (transthoracic aortic cross-clamping) was successfully performed in 392 consecutive, nonemergent patients (345 males; 67.0±9.9 [32–88] years). Another 11 patients were converted to sternotomy intraoperatively. All patients had coronary artery disease with indication to surgical revascularization (three-vessel: 77.6%; two-vessel: 20.4%; left main stenosis: 32.9%). Patients at old age (>80 years: 12.5%), with severe left ventricular dysfunction (EF < 30%: 7.9%), diabetes mellitus (34.9%), massive obesity (BMI > 35: 8.9%), and chronic lung disease (17.1%) were included. Mean EuroSCORE2 was 2.9±2.8. Mean midterm follow-up was 15.2±10.7 [0.06–39.5] months and was completed to 100%.
Results:
Left internal thoracic artery (99.0%), radial artery (70.4%) and saphenous vein (57.4%) grafts were used for total (41.6%) or multiple (29.1%) arterial grafting. 3.0±0.8 (1–5) anastomoses per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right (70.9%) coronary artery. In-hospital outcome regarding mortality, myocardial infarction, repeat revascularization and stroke was 1.3%, 0.5%, 1.0%, and 0.3%, rsp.. During midterm follow-up, death from any cause was 3.1%, myocardial infarction rate was 1.5%, repeat revascularization rate was 5.4%, stroke rate was 0.7% and overall MACCE rate was 8.7%.
Conclusions:
This is the first report of midterm follow-up in unselected patients undergoing TCRAT for multi-vessel coronary artery disease. Outcome was favourable and similar to that of current conventional full sternotomy CABG. Respecting sternal integrity might considerably improve acceptance of surgical myocardial revascularization.

Christian Sellin (1), Ahmed Belmenai (1), Meinolf Voß (1), Volker Schächinger (2), Hilmar Dörge (1), (1) Department of Cardiothoracic Surgery, Heart Center Fulda, Fulda, Germany, (2) Department of Cardiology, Heart Center Fulda, Fulda, Germany

Christian Sellin

Abstract Presenter

CURRICULUM VITAE

 

 

Dr. med. Christian Sellin, MD

 

 

Address                      Clinic of Cardiothoracic Surgery

                                    Heart Center Fulda

                                    Klinikum Fulda

                                    Pacelliallee 4

                                    36043 Fulda

                                    Germany

 

                                    Phone: +49 661 84 5650

                                    e-mail: christian.sellin@klinikum-fulda.de

 

 

Education

1. 2005.                     Medical student at University of Göttingen Medical School

 

Clinical Education

2005-2007                   Department of Thoracic and Cardiovascular Surgery

                                    University of Göttingen (Prof. F.A. Schöndube)

2007-2012                   Resident at the Dept. of Cardiothoracic Surgery,

                                    Heart Center Fulda (Prof. H. Dörge)

 

Positions

2013                            Staff Surgeon (Oberarzt)

                                    Department of Cardiothoracic Surgery,

                                    Heart Center Fulda (Prof. H. Dörge)

2012                            German Board Certified Cardiac Surgeon (Facharzt für Herzchirurgie)