Retrospective Single-surgeon Study Of Outcomes After Minimally Invasive Coronary Surgery For Elderly Patients
Ryota Nakamura1, Keita Kikuchi2, Kunihiko Yoshino3, Ryota Hara3, Yuichi Nakamura1, Akihiko Yamauchi4, Joji Ito3.
1St. Luke’s International Hospital, Tokyo, Japan, 2Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan, 3Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan, 4Yuuai medical Center, Tomishiro, Japan.
BACKGROUND: Minimally invasive coronary surgery (MICS-CABG) is evolved with multivessel bypass grafting from small thoracotomy. Previous research revealed its safety and effectiveness, however, the feasibility to elderly patients such as aged 80 years and older is still unclear. We evaluated the learning curve of MICS-CABG and examined the clinical outcomes of elderly patients.
METHODS: 222 MICS-CABG performed by single-surgeon from 2012 to 2022 were respectively reviewed. The operating time and the number of anastomoses were collected for regression analysis of learning curve. We evaluated surgical outcomes including death in hospital, length of hospital stays, stroke, surgical sight infection, postoperative atrial fibrillation (POAF), newly initiated on dialysis, pneumonia and re-intubation. Patients were divided into subgroups according to age(elderly group, <80years old or non-elderly group, ≥80) to compare.
RESULTS: The Average age was 66±11.4 years old and 157 patients (70.7%) were male. The median operating time was 263 min (IQR, 203.25-316.75 min). Although learning curve didn’t reveal certain turning point, decreasing trend was observed when corrected for the number of anastomoses. The elderly group (≥80 years old, n=27) had longer hospital stay (13.5days [IQR, 10.25-18] vs 11days [IQR, 9-14], p=.017) but there was no difference in other complications. Among the elderly group, the median number of anastomoses were fewer than the non-elderly group (2 [IQR, 1.5-3] vs 3 [IQR, 2-4], p=.005) and tendency of shorter operation time was observed (242 [IQR, 207-282.5] vs 270 [IQR, 202-324], p=.118).
CONCLUSIONS: MICS-CABG demonstrates satisfactory safety and feasibility for elderly patients over 80years old with stable learning curve.
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