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OBJECTIVE:
Sternal-sparing approaches for coronary artery bypass (CAB) surgery have been used at select centers. Adoption of this minimally invasive cardiac surgical (MICS) approach is contingent upon achieving or improving the excellent safety and efficacy outcomes that we expect from conventional sternotomy CAB. In this study, we reviewed our initial experience with MICS-CAB procedures.
METHODS:
From January 2008 to August 2011, data for all patients undergoing isolated CAB procedures at our institution was analyzed. Institutional Society of Thoracic Surgeons (STS) data for 1799 patients was reviewed (ST-CAB=1654 patients, MICS-CAB=145 patients). Baseline characteristics were compared between the two groups, and regression analyses were done to identify independent variables predicting different dependent outcomes.
RESULTS:
The MICS-CAB group demonstrated a selection bias and had a lower rate of redo surgery (p<0.001), use of cardiopulmpnary bypass (CPB) (73% versus 24%, p < 0.001), left ventricular dysfunction (p=0.007) and a lower number of diseased vessels (2.7 ± 0.6 versus 2.13 ± 0.8, p < 0.001). After adjusting all pre-operative and intra-operative independent variables, logistic regression analysis proved MICS-CAB to be an independent predictor of reduced blood product utilization (31% vs. 44%, p = 0.026). Linear regression showed MICS-CAB to be an independent predictor of reduced mean length of stay from surgery to discharge (8.2±8.3 days vs. 9.7±7.3 days, p=0.034). There was no difference in mortality, myocardial infarction, stroke, renal dysfunction or other hard outcomes between the two groups.
CONCLUSIONS:
This experience compares MICS-CAB favorably against ST-CAB. Benefits of this sternal sparing approach include improved cosmesis, reduced length of stay and fewer blood transfusions.