Left thoracotomy approach for off-pump coronary artery bypass grafting surgery: 15 years of experience in 2500 consecutive patients

Gustavo Antonio Guida, Gabriel Alessandro Guida, Vito Domenico Bruno, Mustafa Zakkar, Estefania De Garate, Miriam Terry Pecchinenda, Alfredo Homes, Calogerino Borzellino, Pablo Mendoza, Giuseppina Pecora, Ivan Bonillo, Umberto Benedetto, Antonio Maria Calafiore, Gianni Davide Angelini, Maximo Cosimo Guida

Research output: Contribution to journalArticle (Academic Journal)

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OBJECTIVES: Our goal was to describe the experience at 2 centres with off-pump coronary artery bypass grafting using a left thoracotomy.

METHODS: From January 2002 to December 2017, a total of 2528 consecutive patients (578 women, mean age 62.3 ± 9.1 years) were operated on using this technique. Data were collected prospectively and analysed retrospectively.

RESULTS: There were no conversions to median sternotomy and 6 patients (0.2%) were converted to on-pump CABG. The mean number of grafts per patient was 2.8 ± 0. 9. The 30-day mortality rate was 1.0% (25 patients). Most patients were extubated in the operating theatre (97.3%), and 47 patients (1.9%) needed re-exploration for bleeding. Seven patients (0.3%) experienced a cerebrovascular event; 4 (0.3%) had a postoperative myocardial infarction; and 84 (3.4%) had new-onset atrial fibrillation. A total of 1510 patients (61.1%) were discharged from the hospital in the first 48 h after surgery. Long-term survival rates were 98.8%, 93.6% and 69.1% at 1, 5 and 10 years, respectively (central image). During the follow-up period, 60 patients (2.9%) were re-examined for recurrence of angina with a new coronary angiogram; of those, 24 (1.2%) required percutaneous coronary intervention and 11 (0.5%) had redo surgery.

CONCLUSIONS: A left thoracotomy is a safe alternative to a median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid- and long-term results.

Original languageEnglish
Pages (from-to)271-276
Number of pages6
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number2
Early online date17 Jun 2019
Publication statusPublished - 1 Feb 2020

Structured keywords

  • Centre for Surgical Research


  • Coronary
  • Minimally invasive
  • Off-pump
  • Survival

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