Minimally Invasive Coronary Artery Bypass Grafting Decreases Hospital Stay and Cost

Objective: Minimal invasive extracorporeal circuits (MiECC) have been associated with a significant reduction in the incidence of postoperative atrial fibrillation (AF). Nevertheless, AF remains one of the most common complications following elective primary coronary artery bypass grafting (CABG). The aim of this study was to identify the predictors of AF persisting beyond the hospital stay in elective primary CABG patients. Methods: We conducted a retrospective analysis for the predictors of AF that persisted beyond discharge between all patients who received an elective isolated CABG in our institution between 2009 and 2014. Patients with a positive history for intermittent or persistent AF were excluded from the analysis. Almost all patients were discharged to a rehabilitation facility where they stayed for 3 to 4 weeks postoperatively. At rehab approximately 91% of them received Holter monitoring at least once prior to their discharge. Results: A total of 770 patients were included in the analysis of which 763 patients survived the in-hospital stay. The incidence of AF at hospital discharge was 4.2% (32/763) while that on Holter monitor at Rehab was 1.5% (10/685). Age and the type of extracorporeal circuit (ECC) utilized were the only significant predictors for both AF at discharge ( p < 0.01 both) and on Holter monitor in rehab ( p < 0.01 and 0.02, respectively). This was also confirmed on multivariate analysis. Conclusion: Our findings show that the benefits of MiECC regarding the incidence of postoperative AF persist beyond hospital discharge. They may thus positively influence the outcomes of patients beyond the early postoperative period.

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Integrated minimally invasive direct coronary artery bypass grafting and angioplasty for coronary artery revascularization

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(02)00262-2 ◽

2002 ◽

Vol 22 (2) ◽

pp. 261-265 ◽

Cited By ~ 42

Author(s):

M Cisowski

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Coronary Artery Revascularization

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Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1670632 ◽

2018 ◽

Vol 67 (06) ◽

pp. 437-443 ◽

Cited By ~ 2

Author(s):

Mahmoud Diab ◽

Gloria Färber ◽

Christoph Sponholz ◽

Raphael Tasar ◽

Thomas Lehmann ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Term Survival ◽

Artery Bypass Grafting ◽

Off Pump ◽

Sf 36

Abstract Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA. Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36). Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire. Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.

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