Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome

Abstract

Introduction:Minimally invasive (MI) cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG) surgery.Methods:This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group) from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group). Demographic, intra- and post-operative variables were collected.Results:In MI group, duration of the surgery was significantly longer (P = 0.029). Intraoperative blood loss lesser (P = 0.002), shorter duration of ventilation (P = 0.002), shorter Intensive Care Unit stay (P = 0.004), shorter hospital stay (P = 0.003), lesser postoperative analgesic requirements (P = 0.027), and lower visual analog scale scores on day of surgery (P = 0.032) and 1st postoperative day (P = 0.025). No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality.Conclusion:MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.

Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

“…Although MI method has several benefits, it was also associated with increased technical difficulty posed by the reduced surgical field and longer duration of surgery. Similar to our results, Baishya et al found significantly longer surgery duration in MI CABG [16].…”

“…The second postoperative early outcome of this study was that Group C had longer duration of MV in ICU than Group M (12 h vs. 8 h) with re-intubation of 2 patients in each group. Similar to our results, Baishya et al (4 vs. 8 h) and Poston et al (4 vs. 12 h) found shorter duration of MV in ICU in MI group compared to conventional group [16,25]. García-Delgado et al reported that CPB causes lung injury with an intense systemic inflammatory syndrome and increased lung capillary permeability.…”

“…Eleven patients (22%) in Group C had prolonged ICU stay between 48 h and 30 days. Group [16]. Previous studies noted prolonged ICU LOS up to 45% of the patients with a wide range between 48 h to 10 days [17][18][19][20][21][22][23].…”

Robotic coronary artery surgery: Outcomes and pitfalls

“…15 Furthermore, various studies have demonstrated that the MIDCAB procedure is favorable in terms of recovery patterns, long-term survival, and graft patency as compared with conventional approaches. 16 MIDCAB is achieved through a minithoracotomy approach, which requires a significantly smaller incision size. It is performed via a small anterolateral thoracotomy through which the heart is visualized.…”

A comparative study to assess neurocognitive functions between off pump and on pump coronary artery bypass surgery patients

“…Off-pump procedures, though more technically complex, are thought to be less invasive and only appropriate for a subgroup of CABG candidates. 2,3 Due to advancement in surgical techniques it has resulted in older patients, and severe CAD patients with comorbid medical conditions being treated with CABG surgery. The cardiac surgery exposes brain to ischemic injury and following CABG, type II complications like deterioration in cognitive function, confusional state, memory deficit, or seizure without a stroke are more frequent than type I (death due to stroke or hypoxic encephalopathy, nonfatal stroke, transient ischemic attack, stupor or coma) and considerable variation in their rates is reported (3-79%).…”