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Minimally Invasive Direct Coronary Artery Bypass Graft Surgeries Lead To Better Outcomes
Nishanthan Shanthanayagam, Oshani D. Jayathissa, Amadoru Harischandra, Rajitha Y. Silva;
Sri jayewardenepura general hospital, Nugegoda, Sri Lanka
BACKGROUND:The minimally invasive direct coronary artery bypass grafts (MIDCABs) surgeries are known to facilitate early recovery after cardiac surgery. This study analyses the outcome of MIDCABs
METHODS:This retrospective descriptive study included all the MIDCABs done from February 2014 to march 2023 with a total of 448 surgeries in a single institution. There are only 282 patients’ data available to analyse. All the data were derived from both electronic and hard copies of BHTs (Bed head tickets) available with the support of IT (information and technology) department. The data were analyzed using IBM SPSS version 23.0
RESULTS:The mean age of patient population was 56.09±9.67 years. 206(73%) of them were Males. There were 212 (75.2%) single vessel MIDCABs,55(19.5%) multi vessel MIDCABs and 15(5.3%) Hybrid surgeries Pre operative ejection fraction was ≥55 in 73.2%, 40-54 in 25.4% and 25-39 in 1.3 %. The diseased vessels of 278 LAD (Left anterior descending artery) s,35 OM1(Obtuse marginal artery 1) s,5 OM2s,2 OM3s, 7 RI (Ramus intermedius artery) s and 15 D1(diagonal artery1) s were grafted. 282 (82.45%) LIMA (Left internal mammary artery), 48(14.03%) Left GSV (great saphenous vein), 08(2.33%) Right GSV, 03(0.87%) left RA (Radial artery) and 01(0.003%) right RA graft were used for grafting. There were 6(2.2%) reopening for tamponade and 4(1.5 %) patients had post operative cardiac arrest and were resuscitated back. None had myocardial infarction.14(5.2%) patients had AF (atrial fibrillation) and 2(O.7%) had VF (ventricular fibrillation). There were 6 (2.2 %) patients who had pleural effusion and 3 (1.1%) had pneumothorax which required intervention.12(4.5%) patients had AKI (Acute kidney injury). Continuous renal replacement therapy and dialysis were required in 3(1.1%) patients each. There was no in hospital mortality. 3(1.1%) had Cerebro vascular accidents and 3(1.1%) had Surgical site infection at thoracotomy site. The average ICU (Intensive care unit) stay was 3.35 ± 1.864 days. The average post op hospital stay was 6.52±3.232 days.
CONCLUSIONS:Minimally invasive direct coronary artery bypass shows good post operative outcomes and paves the way for early recovery after cardiac surgery. Prospective randomized trials comparing MIDCABs and conventional Coronary artery bypass grafts would give better evidence
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