Stress Caused by Minimally Invasive Cardiac Surgery versus Conventional Cardiac Surgery: Incidence of Systemic Inflammatory Response Syndrome

Abstract

The present study was conducted to evaluate the degree of stress in patients induced by minimally invasive cardiac surgery (MICS) in comparison with that caused by conventional cardiac surgery. We did this by assessing the incidence of systemic inflammatory response syndrome (SIRS). A total of 48 adult patients who underwent surgery for single valve disease were included in this study, 27 of whom underwent conventional surgery and 21 MICS. We evaluated the stress inflicted on the patients in these two groups by analyzing the duration and degree of SIRS and the level of C-reactive protein (CRP). SIRS was assessed by measuring body temperature, heart rate, respiratory rate, and white blood cell counts. There were no significant differences in the operating times, perfusion times, or aorta clamp times between the two groups; and the mean volume of blood transfusion did not differ significantly either. There was no significant difference in the incidence of SIRS or the mean duration of SIRS between the two groups. The CRP levels did not differ significantly between the two groups. Thus although MICS is superior to conventional cardiac surgery in that only a small skin incision is required, the stress experienced by the patient may be the same as that experienced by the patient undergoing conventional cardiac surgery.

Minimally-Invasive Valve Surgery

“…Thus, patient-related factors are a significant advantage of mini-VS. In concordance with their findings, Yamada et al (60) in 2003 compared early post-operative quality of life in mini-VS and conventional valve surgery.…”

“…The addition of a voice-activated robotic camera led to a decrease in blood loss as well as in CPB and cross-clamp times (27). Three of 10 studies found reduced transfusion requirements with a minimally-invasive approach compared with conventional surgery (14,47,48), whereas the others showed no difference (17,27,32,43,49,54,60). In patients 70 years or older, Grossi et al (47) found reduced plasma transfusions with a minimally-invasive (n ϭ 111) compared with a conventional (n ϭ 259) approach.…”

Minimally invasive mitral valve surgery: a systematic review and meta-analysis

“…Three of 10 studies showed reduced transfusion requirements with a minimally invasive approach, compared to conventional surgery [8,23,25] whilst the others showed no difference [6,12,14,19,21,26,32]. Too few studies met the inclusion criteria for meta-analysis (percent transfused, two studies; units transfused, three studies).…”

“…Of the 16 studies reporting cardiopulmonary bypass times, 10 described longer durations for MIMVS. Seven of 14 groups reported longer aortic crossclamp times [6,8,12,14,[18][19][20][21][22][23][24][25][26][27][28][29][30]. Meta-analysis of eligible studies showed significantly longer CPB (871 patients, WMD 25.81, 95% CI 13.13-38.50, p < 0.0001) and XC times (671 patients, WMD 20.91, 95% CI 8.79-33.04, p = 0.0007) with the minimally invasive approach.…”

“…This evidence should ideally come from large, multicenter prospective randomized controlled trials (RCT) that compare minimally invasive with conventional sternotomybased mitral surgery. However, there are only two small RCTs, one of which reports data combined with minimally invasive aortic valve replacement [5,6]. The ability to conduct an effective RCT now would be compromised severely as patients and healthcare providers have preconceived notions www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 34 (2008) [943][944][945][946][947][948][949][950][951][952] about surgical approaches.…”