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Comparative Study
. 2024 May;52(5):3000605241247656.
doi: 10.1177/03000605241247656.

Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach

Li Jinghui  1   2 , Yang Yin  1   2 , Muhetaer Xiaokaitijiang  2 , Tang Yipeng  1 , Wang Lianqun  1 , Bai Yunpeng  1 , Zhang Zhejun  1 , Jiang Nan  1 , Wang Qiang  1 , Chen Qingliang  1 , Xu Dong  1 , Yang Dongyan  1 , Guo Zhigang  1 , Zhao Feng  1
Affiliations
Comparative Study

Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach

Li Jinghui et al. J Int Med Res. 2024 May.

Abstract

Objective: To compare the clinical effects of coronary artery bypass grafting (CABG) between the left anterior small thoracotomy (LAST) and lower-end sternal splitting (LESS) approaches for coronary artery disease.

Methods: In total, 110 patients who underwent LAST from October 2015 to December 2020 in Tianjin Chest Hospital were selected as the observation group. Patients who underwent the LESS approach during the same period were analyzed. The propensity score was calculated by a logistic regression model, and nearest-neighbor matching was used for 1:1 matching.

Results: The length of hospital stay and ventilator support time were significantly shorter in the LAST than LESS group. The target vessels in the obtuse marginal branch and posterior left ventricular artery branch grafts were significantly more numerous in the LAST than LESS group, but those in the right coronary artery graft were significantly less numerous in the LAST group.

Conclusions: CABG using either the LAST or LESS approach is safe and effective, especially in low-risk patients. The LAST approach can achieve complete revascularization for multivessel lesions and has the advantages of less trauma and an aesthetic outcome. However, it requires a certain learning curve to master the surgical techniques and has specific surgical indications.

Keywords: Coronary artery disease; coronary artery bypass grafting surgery; left anterior small thoracotomy; lower-end sternal splitting; minimally invasive; multivessel lesion; revascularization.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart.
Figure 2.
Figure 2.
LAST incision. LAST, left anterior small thoracotomy.
Figure 3.
Figure 3.
Proximal graft anastomosis.
Figure 4.
Figure 4.
Distal end of the graft.
Figure 5.
Figure 5.
LAST surgical panorama. LAST, left anterior small thoracotomy.
Figure 6.
Figure 6.
LAST incision length. LAST, left anterior small thoracotomy.
Figure 7.
Figure 7.
LESS incision. LESS, lower-end sternal splitting.
See this image and copyright information in PMC

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