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Minimally Invasive Coronary Artery Bypass Grafting is Associated with Improved Clinical Outcomes
Prem Rabindranauth1, Jacob G. Burns2, Todd T. Vessey1, Michelle A. Mathiason2, Kara J. Kallies2, Venki Paramesh1.
1Gundersen Lutheran Health System, La Crosse, WI, USA, 2Gundersen Lutheran Medical Foundation, La Crosse, WI, USA.

OBJECTIVE: Minimally invasive coronary artery bypass grafting (MICS-CABG) via left mini-thoracotomy is an acceptable alternative to conventional off-pump coronary artery bypass (OPCAB) surgery via a sternotomy. Our objective was to evaluate the clinical outcomes after MICS-CABG versus OPCAB.
METHODS: The medical records of patients who underwent MICS-CABG from 12/7/2009-12/12/2011 and OPCAB from 1/1/2005-4/30/2011 were reviewed. OPCAB patients were matched 2:1 to MICS-CABG patients by age, sex, preoperative ejection fraction, creatinine, and history of diabetes and myocardial infarction.
RESULTS: 130 consecutive patients who underwent MICS-CABG were matched with 260 patients who underwent OPCAB. Overall, mean age was 66.2 years and 24.6% were female. Mean number of bypasses was 2.1 and 3.2 in the MICS-CABG and OPCAB groups, respectively (P=0.001). Extubation in the operating room (OR) occurred in 70.0% and 12.7% of patients in the MICS-CABG and OPCAB groups, respectively (P=0.001). Mean postoperative length of stay was 4 days in the MICS-CABG versus 5 days in the OPCAB group (P=0.002), and 3.8 days versus 4.6 days for MICS-CABG patients extubated in the OR versus those that remained intubated (P=0.007). There were zero 30-day mortalities in the MICS-CABG group and 1 in the OPCAB group (P=0.999). Thirty-day readmissions rates were similar between the two groups (6.4% and 7.5% in the MICS-CABG and OPCAB groups, respectively; P=0.827).
CONCLUSIONS: MICS-CABG is safe, and early clinical outcomes are comparable, if not superior, to OPCAB. Extubation in the OR is feasible, well-tolerated, and was associated with earlier discharge. Shorter hospital stays may decrease resource utilization and promote earlier return to activities; however, further research is needed.


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