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Perioperative Outcomes of Minimally Invasive Coronary Artery Bypass Compared to Sternotomy Coronary Artery Bypass Grafting
Limael E. Rodriguez, Dewei Ren, Basel Ramlawi, Mahesh Ramchandani.
Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.

OBJECTIVE: Minimally invasive coronary artery bypass (MICS CAB) is a well established technique for revascularization. Studies have shown excellent long-term graft patency with these techniques. This study compares perioperative data of consecutive patients who underwent MICS CAB on the beating heart versus sternotomy coronary artery bypass grafting (CABG).
METHODS: Sternotomy CABG was compared to mini thoracotomy MICS CAB, which was performed both with and without cardiopulmonary bypass (CPB). Consecutive cases from May 2009 to April 2012 were reviewed from the STS database and analyzed for demographics, risk factors, and other covariates (Table 1).
RESULTS: Most MICS CAB procedures were ≤ 2 vessel bypass, while CABG procedures were primarily >2 vessels. MICS CAB patients had more previous percutaneous coronary intervention (PCI) and/or CABG. Sternotomy CABG used more blood products and had significantly longer total ventilator times. MICS CAB subjects had reduced operative time (22%), ICU time (26%), and length of stay (29%; p<0.001). There were no significant differences in complications, intraoperative mortality, or 30-day post-operative mortality between the two groups. The average total cost of hospital admission including surgical fees was $45,065 for MICS CAB versus $49,745 for sternotomy CABG.
CONCLUSIONS: Compared to sternotomy CABG, MICS CAB offers several perioperative benefits, including reductions in length of stay, need for hemodynamic supportive measures, postoperative recovery time, and total operating cost. MICS CAB can be performed safely with low perioperative morbidity or mortality comparable to CABG. Our data demonstrates significant clinical, logistical, and overall benefits of MICS CAB when employed in an experienced care center.


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