Early Outcomes in Severely Obese Patients Undergoing Sternum-sparing Minimally Invasive Multivessel Coronary Artery Bypass Grafting (TCRAT)

Background: Severe obesity is a risk factor for sternotomy-associated complications in patients undergoing standard full sternotomy coronary artery bypass grafting (CABG). Conversely, especially severely obese patients are often excluded from minimally invasive sternum-sparing approaches. The present study investigated the feasibility and safety of the recently introduced sternotomy-avoiding TCRAT technique for multivessel coronary artery bypass grafting (CABG) in patients with severe obesity.

Methods: Between November 2019 and May 2024, CABG via left anterior mini-thoracotomy with cardiopulmonary bypass (CPB) and cardioplegic cardiac arrest was performed in 502 consecutive non-emergency patients with multivessel coronary artery disease. Among these, 43 severely obese patients (BMI > 35.0 kg/m²) were compared with 459 non-severely obese patients (BMI < 35.0 kg/m²) with regard to intraoperative parameters, including operation duration, CPB time, aortic cross-clamp time, and graft configuration. Postoperative outcomes, such as the incidence of major adverse cardiac and cerebrovascular events, minor complications, and length of stay in ICU and hospital, were also analyzed.

Results: Severely obese patients exhibited a longer total operation time (353.5 ± 83.6 minute versus 320.4 ± 73.4 minutes, p < 0.05). However, no differences were observed in aortic cross-clamp time (97.9 ± 27.6 minutes versus 95.6 ± 33.0 minutes, n.s.) or CPB time (163.3 ± 35.0 minutes versus 155.0 ± 42.9 minutes, n.s.). The number of distal anastomoses per patient (3.1 ± 0.7 versus 3.0 ± 0.8, n.s.) and the rate of multi-arterial grafting (64.9% versus 69.8%, n.s.) showed no differences between the groups. There were no differences between the groups in major complications, including hospital mortality (1.1% versus 2.3%), stroke (0.6% versus 0%, n.s.), or need for re-revascularization (1.1% versus 0%). Similarly, minor complications, such as wound healing issues (2.3% versus 1.1%) and revisions for bleeding (7.2% versus 4.6%), were comparable between the groups. The length of stay in the ICU was 2.2 ± 4 days versus 2.7 ± 4.5 days, and the length of hospital stay was 10.8 ± 8.6 days versus 12.3 ± 9.6 days, n.s.

Conclusion: TCRAT can be performed safely and effectively in severely obese patients, providing a feasible minimally invasive option for complete coronary revascularization in cases of multi-vessel disease. This approach eliminates the complications associated with sternotomy, making it a valuable surgical alternative for this high-risk patient group.

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Artikel online veröffentlicht:
11. Februar 2025