Advantages of an inverted J-shaped partial sternotomy in off-pump revascularization of the left anterior descending coronary artery

Amac: Bu calismada sol on inen (LAD) koroner arterin cerrahi revaskularizasyonunu gerektiren olgularda atan kalpte tam uzunlukta medyan sternotomi (FLMS) insizyonu ile ters J kismi sternotomi (IJPS) insizyonunun klinik sonuclari karsilastirildi. Ca­lis­ma­ pla­ni:­ Ocak 2008 Ocak 2011 tarihleri arasinda LAD koroner arterin atan kalpte cerrahi revaskularizasyonu yapilan 119 hastanin (79 erkek, 40 kadin; ort. yas 61.6±10.7 yil) verileri retrospektif olarak incelendi. Hastalar retrospektif ve nonrandomize olarak IJPS veya FLMS gruplarina ayrildi. Ters J kismi sternotomi grubunda 46 hasta (23 erkek, 23 kadin) ve FLMS grubunda 73 hasta (56 erkek, 17 kadin) vardi. Her iki grubun ameliyat oncesi, ameliyat sirasi ve erken donem ameliyat sonrasi verileri retrospektif olarak birbirleriyle karsilastirildi. Bul gu lar: Her iki grubun demografik ozellikleri benzer idi. Her iki grupta da mortalite, erken greft yetmezligi ve miyokard infarktusu gozlenmedi. Ters J kismi sternotomi grubunda FLMS’ye donme gerekliligi olmadi. Ters J kismi sternotomi grubunda mekanik ventilasyon suresi daha kisa idi (429.45±267.3 dakikaya kiyasla 209.67±109.7 dakika, p 0.05). Ameliyat sureleri acisindan iki grup arasinda farklilik saptanmadi. Ameliyat sonrasi kanama miktarlari (FLMS ve IJPS grubunda sirasiyla 418±72 mL’ye kiyasla 453±87 mL, p 0.05), iki grup arasinda istatistiksel acidan anlamli farklilik yoktu. Tam uzunlukta medyan sternotomi grubunda sadece bir adet sternum dekolmani gozlendi (%1.26). Ters J kismi sternotomi grubunda sternal ayrisma gozlenmedi. Cerrahi insizyon enfeksiyonu IJPS grubunda bir hastada (%3.3), FLMS grubunda dort hastada (%5) gozlendi. So­nuc:­Ters J kismi sternotomi insizyonu ile LAD koroner arter revaskularizasyonu guvenli bir sekilde ve iyi estetik sonuclar elde edilerek yapilabilir. Ters J kismi sternotomi LAD koroner arterin revaskularizasyonunda daha az cerrahi travma ile iyi bir alternatif yontem olarak gorunmektedir. Anah tar soz cuk ler: Hemisternotomi; minimal invaziv kalp cerrahisi; atan kalpte koroner arter cerrahisi; kismi sternotomi. 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 1-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 0.05). 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), 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 IJPS 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.