Minimally Invasive Caridac Surgery In High Risk Patients
Yoshitsugu Nakamura, Yusuke Nakanishi, Miho Kuroda, Yuki Endo, Yujiro Ito, Takaki Hori.
Chibanishi general hospital, Chiba, Japan.
OBJECTIVE: Efficacy of minimally invasive cardiac surgery through the right mini-thoracotmy (MICS) in high-risk patients has not been fully discussed. This study aimed to assess early surgical outcomes and postoperative recovery of MICS in high-risk patients by comparing with those in low-risk patients.
METHODS: We reviewed our database of consecutive 250 patients who underwent MICS at out institution from 2014 to 2016. The patients were stratified into high-risk group (H group: EuroSCORE II 5 or greater) and low-risk group (L group: EuroSCORE II less than 5).
RESULTS: H groups included 45 patients with mean age 75 +/- 8 years and L groups included 205 patients with mean age 69 +/- 13 years. Mean EuroSCORE II was 11.9 +/- 8.5 in H group and 1.8 +/- 1.1 in L group (p<0.01). There was no significant difference in the preoperative comorbidities (hypertention, diabetes mellitus, chronic kidney disease, COPD, congestive heart failure, infective endocarditis) except for end-stage renal failure on hemodialysis (9% H group vs. 1 % L group). There was one hospital death in each group. There was no significant difference in the postoperative complication rate (stroke, respiratory failure, cardiac failure, re-exploration, acute kidney injury, atrial fibrillation, wound infection). The blood transfusion rate was significantly higher in H group (82 % H group vs. 30% L group, p < 0.01). Postoperative intubation time (17 hours H group vs. 11 hours L group, p < 0.01), intensive care (5.3 days H group vs. 2.9 days L group, p < 0.01) and hospital (19.0 days H group vs.11.8 days L group, p < 0.01) stay were longer in H groups.
CONCLUSIONS: MICS provides satisfactory surgical outcomes for high-risk patients as well as low-risk patients although postoperative recovery was delayed in high-risk patients.<!--EndFragment-->
Back to 2017 Display Posters