Minimal Invasive Total Arterial Coronary Artery Bypass Grafting in Obese Patients
Bibliographic record
Abstract
All articles of this category (opens in new window) Background: Minimal Invasive Total Arterial Coronary Artery Bypass Grafting (MICS-CABG) is a promising surgical approach, which enables the operative treatment of coronary artery disease without median sternotomy and its complications. Obese patients with a body mass index (BMI) of 30 or higher have a higher risk for sternal wound infection and would benefit more from this approach. On the contrary, these patients are usually deprived from this approach because of presumed higher technical complexity. With growing expertise, we include all patients with isolated multivessel CAD without emergent indication for MICS-CABG. In our study, we therefore compared the perioperative and mid-term outcomes of MICSCABG in obese (BMI >30) versus nonobese (BMI<30) patients. Methods: Between January 2015 and March 2023, a total of 241 patients underwent off-pump MICS-CABG via left intercostal thoracotomy in Heart Center Leipzig. Patients' data was collected prospectively and was retrospectively analyzed. For the sake of the analysis, patients were subdivided into 2 main subgroups: obese ( n = 50) and nonobese ( n = 191). Primary objectives were 30-day survival and perioperative myocardial infarction. Secondary objectives were mid-term survival and MACCE. Results: The mean age was 66 years (±7) and most of the patients were males ( n = 212). Median BMI was 26.0 (23.9–27.7) vs. 31.2 (30.8–32.3), p ≤ 0.001. Several preoperative risk factors such as Diabetes mellites pulmonary hypertension, COPD, and peripheral vascular disease were significantly higher in the obese subgroup (26% vs. 58%, p ≤ 0.001, 5.8% vs. 18%, p = 0.009, 7.3% vs. 22%, p = 0.002, 16% vs. 28%, p = 0.016 respectively) so as Euro Score II (1.70 (0.99–3.26) vs. 2.32 (1.27–3.72), p = 0.025). Length of surgery was longer in the nonobese group (250 ± 62.7 vs. 276.3 ± 63.8, p = 0.04) as they received in mean significantly greater number of distal anastomosis (2.36 vs. 2.29, p = 0.04). No intraoperative conversion to sternotomy in both groups was registered. The rate of thoracotomy for bleeding and perioperative myocardial were also similar in both groups. 30-day survival was 99.6% for the whole cohort. No difference regarding perioperative myocardial infarction was found between both arms of the study (7.3 vs. 4.0, p = 0.54). Mid-term data showed no difference in survival or MACCE rate between both groups ( p = 0.87 and p = 0.83, respectively). Conclusion: MICs-CABG is safe and feasible for obese and nonobese patients alike. Obesity should not be an exclusion criterion in high volume centers for MICs-CABG. Publication History Article published online: 13 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".