Is median sternotomy invasive? A comparison between minimally invasive direct coronary artery bypass and off-pump bypass.

Although minimally invasive direct coronary artery bypass (MIDCAB) eliminates the need for median sternotomy and cardiopulmonary bypass, its indications are limited. Conversely, coronary artery bypass without cardiopulmonary bypass (off-pump bypass) enables complete surgical revascularization under an optimal surgical field established by median sternotomy, even if patients have multivessel disease. The present study was designed to determine the invasiveness of median sternotomy by comparing 11 patients who underwent MIDCAB and 5 who underwent off-pump bypass between May 1997 and April 1998. There were no significant differences between the MIDCAB group and the off-pump group in age, being 57 +/- 11 vs 66 +/- 8 years old, the operative time, being 321 +/- 149 vs 441 +/- 205 min, the number of grafts, being 1.0 vs 1.4/patient, peak creatine kinase (CK) values, being 662 +/- 436 vs 609 +/- 56 IU/l, the peak CK-muscle-brain values, being 12 +/- 9 vs 16 +/- 5 IU/l, and the postoperative blood loss, being 369 +/- 198 vs 541 +/- 204 ml. Although there was no significant difference in peak C-reactive protein, at 17 +/- 5 vs 20 +/- 2 mg/dl, the periods declining within the normal ranges were shorter in the MIDCAB group than in the off-pump group, at 7 +/- 1 vs 15 +/- 2 days (P > 0.01). The hospital stay was almost the same in both groups, at 16 +/- 8 vs 26 +/- 14 days. These findings suggest that off-pump bypass is more invasive than MIDCAB, which may be attributed to the median sternotomy.