International Society For Minimally Invasive Cardiothoracic Surgery

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Excellent Results Of Both Opcab And Oncab In A Residency Teaching Program
Ramachandra Reddy, Amit Pawale, Ken McCardle, Julie Swain, Farzan Filsoufi.
Mount Sinai Medical Center, New York, NY, USA.

Coronary artery bypass grafting (CABG) remains the gold standard for the treatment of the majority of patients with severe three vessel coronary artery disease. It has been suggested that teaching this procedure, particularly on a beating heart to young residents is challenging given the increased acuity of the current patient population and the pressure of public reporting. Here we report our contemporary results in a teaching institution where residents play a critical role. Methods: From 2011 to 2017, 1,113 patients underwent isolated CABG by 2 senior surgeons one of whom performed almost exclusively OPCAB (576) and the other almost exclusively ONCAB (537). All procedures were performed by a team consisting of an attending, a resident and a PA. The critical role of the resident was defined according to their level and ability as preoperative preparation, opening and closing the chest, taking the mammary artery down and performing portions of all anastomoses, besides postoperative care. We analyzed results in terms of the total cohort and the on and off pump procedures (Table .1)

Total Cohort OPCABONCABP-value
Demographics
Number of Patients1113576537
Mean age (SD) 64.3 (10.3)65.3 (9.9)0.08
Diabetes718 (64.5%)393 (68.2%)325 (60.5%)0.007
Severe lung disease35 (3.1%)28 (4.9%)7 (1.3%)<.001
PVD147 (13.2%)81 (14.1%)66 (12.3%)0.38
CHF246 (22.1%)135 (23.4%)111 (20.7%)0.27
Preop MI within 21 days190 (17%)114 (19.8%)76 (14.2%)0.013
Previous PCI366 (32.8%)184 (31.9%)182 (33.9%)0.49
EF <30%101 (9.1%)59 (10.2%)42 (7.8%)0.17
EF 30-50%362 (32.5%)194 (33.7%)168 (31.3%)0.39
EF >50%650 (58.4%)323 (58.4%)327 (60.9%)0.1
Redo operation48 (4.4%)25 (4.3%)23 (4.3%)0.96
Intra-Operative data
Conversion off to on pump 42 (7.3%) 0.008
Mean IMA grafts (SD) 1.3 (0.8)1.2 (0.7)0.17
Mean distal veins (SD) 2.2 (1.0)2.3 (0.8)<.17
Median Procedure Time Minutes (IQR) 233 (78)304 (72)<.01
Results
Mortality 9 (0.8%)6 (1.0%) 3 (0.6%)0.37
Stroke13 (1.2%)8 (1.4%)5 (0.9%)0.09
Renal failure 11 (1%)10 (1.7%)1 (0.2%)0.009
Deep infection 11 (1%)7 (1.2%)4 (0.7%)0.43
Reop bleeding19 (1.7%)15 (2.6%)4 (0.7%)0.017

Conclusion: Teaching CABG surgery is safe both on and off pump with excellent outcomes.


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