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Mics Cabg, A Single Centre Experience Of First 300 Cases
Lalitaditya Malik;
Manipal Hospital, jaipur, India
BACKGROUND:METHODS:RESULTS:Objective : To study the learning curve and outcomes of the first 300 cases of minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG) performed at our center.
Methods: From May 2018 to june 2023, a total of 300 patients underwent CABG via left anterior thoracotomy approach. We have studied the operative times within the MICS CABG patients to analyze our learning curve. We also studied the postoperative outcomes and compared these with those of patients who underwent sternotomy during the same period.
Results: The mean age was 55.33 ± 9.95 (range 32-87) years. The numbers of males and females were 212 and 88 respectively. The preoperative average ejection fraction (EF) was 45.08 ± 9.75%. All these patients underwent CABG via left thoracotomy approach, after satisfying the exclusion criteria. All patients received left internal mammary artery (LIMA) to left anterior descending (LAD) as a standard graft, with the radial artery and saphenous vein being the next alternative conduits. The average length of the incision was 5.55 ± 0.45 cm. Only 4 cases were done on pump. The average number of grafts per patient was 2.88 ± 0.88. The mean operative time was 152.40 ± 10.56 min. The mean duration of ventilation was 6.88 ± 1.90 h and average intensive care unit (ICU) stay was 2.52 ± 0.84 days. There was five conversion and no mortalities in our study. We had analyzed our operative times and noticed a significant reduction after the first 40 cases, which was our learning curve.
Conclusion: MICS CABG can be performed for multivessel disease with the same comfort as for a single,double vessel or Triple vessels disease, once the learning curve has been achieved. Only significant difference from the sternotomy approach was noted in the longer operative times for MICS CABG during the learning curve, and not thereafter. Significant benefits of MICS over sternotomy were noticed in the immediate postoperative parameters like duration of ventilation, mean drainage, postoperative pain, ICU stay, and hospital stay, with no difference in postoperative adverse events.
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