Is Single LIMA-LAD Bypass Appropriate for OPCAB Training? A Retrospective Comparison of Outcomes between Trainees and Consultant Surgeons

Objectives: Previous large-scale studies revealed the significant impact of surgeons´ experience on outcomes of off-pump coronary artery bypass (OPCAB) grafting. Therefore, the establishing of a safe OPCAB-training pathway is warranted. Single LIMA-LAD bypass under direct supervision by an experienced OPCAB surgeon might be a reasonable first step for OPCAB training.

Methods: A total of 180 consecutive patients, who were referred for isolated surgical single coronary revascularization using LIMA in situ for LAD stenosis to our institution between January 2010 and June 2019, were retrospectively analyzed. CABG with cardiopulmonary bypass, utilizing other graft material, MIDCAB through left side thoracotomy, and multiple coronary artery diseases were excluded. In-hospital outcome (MACCE: myocardial infarction, coronary revascularization, stroke, acute renal failure, and all causes of death) was compared between experienced surgeons (group 1: n = 117) and residents in training under supervision (group 2: n = 63). Residents were already trained in on-pump coronary artery bypass grafting.

Result: Preoperative variables were comparable. In group 1, seven redo procedures were included. There was no significant difference in the rate of MACCE event between the two groups. For details, see [Table 1].

Table 1

	Group 1 (n = 117)	Group 2 (n = 63)	p-Value
STS morbidity, median	6.109	6.218	0.687
Hospital death, n (%)	2 (1.7%)	0	0.297
Surgical revision 30-day, n (%)	3 (3%)	2 (3%)	0.812
PCI 30-day, n (%)	0	1 (2%)	0.170
Myocardial infarction 30-day, n (%)	1 (1%)	2 (3%)	0.246
Stroke 30-day, n (%)	1 (1%)	1 (2%)	0.655

Conclusion: The hospital outcome after LIMA-LAD OPCAB by residents was not inferior to experienced surgeon. Single LIMA-LAD was safely performed by residents in training under supervision without cardiopulmonary bypass. To master OPCAB technique, LIMA-LAD might be a reasonable first step to get into touch with the technical characteristics of this special procedure.

Publication History

Article published online:
19 February 2021