Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

Keywords: coronary artery bypass, minimally invasive, total coronary revascularization, TCRAT, postoperative outcome.

Abstract

Minimally invasive coronary artery bypass grafting (CABG) is a new technique developed in recent years apart from the conventional method. Our first objective is to compare the postoperative early outcomes of conventional and minimally invasive multivessel (MIM) CABG methods, and second objective is to compare perioperative differences between two surgical techniques. This retrospective, comparative study was conducted at a university hospital with 100 patients, who underwent CABG surgery from November, 1 2019 to June, 1 2020. The data of 50 patients, who underwent MIM CABG (Group M), was certain. Among the patients operated with the conventional method (Group C), 50 patients were randomly selected from the same time period. Examination of early postoperative outcomes revealed that Group C had significantly higher intensive care unit (ICU) stay (p=0.013), significantly higher mechanical ventilation time in ICU (p<0.001), and significantly higher isolated systolic blood pressure (p=0.013). Examination of perioperative variables revealed that Group C had significantly shorter duration of surgery (p<0.001), significantly shorter aortic cross-clamp time (p<0.001), significantly shorter cardiopulmonary bypass (CPB) time (p<0.001), significantly lesser graft numbers (p<0.001), significantly lesser left internal mammary artery use (p<0.05), and significantly lesser inotropic support after CPB was discontinued (p<0.05). In the light of these results, MIM CABG was associated with enhanced postoperative early outcomes with prolonged surgery time compared to conventional method.

References

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: Heart disease and stroke statistics--2016 update: A report from the American Heart Association. Circulation. 2016;133(4):447-54. https://doi.org/10.1161/CIR.0000000000000366
  2. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR Jr, Morel MA, Van Dyck N, Houle VM, Dawkins KD, Serruys PW. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381(9867):629-38. https://doi.org/10.1016/S0140-6736(13)60141-5
  3. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367(25):2375-84. https://doi.org/10.1056/NEJMoa1211585
  4. Penttilä HJ, Lepojärvi MV, Kiviluoma KT, Kaukoranta PK, Hassinen IE, Peuhkurinen KJ. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass. Ann Thorac Surg. 2001;71(2):565-71. https://doi.org/10.1016/s0003-4975(00)02002-6
  5. Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1998;115(6):1273-7; discussion 1277-8. https://doi.org/10.1016/S0022-5223(98)70209-0
  6. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25years. J Am Coll Cardiol. 1996;28(3):616-26. https://doi.org/10.1016/0735-1097(96)00206-9
  7. Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol. 2010;56(6):455-62. https://doi.org/10.1016/j.jacc.2010.03.053
  8. Merk DR, Lehmann S, Holzhey DM, Dohmen P, Candolfi P, Misfeld M, Mohr FW, Borger MA. Minimal invasive aortic valve replacement surgery is associated with improved survival: a propensity-matched comparison. Eur J Cardiothorac Surg. 2015;47(1):11-7. https://doi.org/ 10.1093/ejcts/ezu068
  9. Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via asmall thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg. 2011;40(4):804-10. https://doi.org/10.1016/j.ejcts.2011.01.066
  10. Ruel M, Une D, Bonatti J, McGinn JT. Minimally invasive coronary artery bypass grafting: is it time for the robot? Curr Opin Cardiol. 2013;28(6):639-45. https://doi.org/10.1097/HCO.0b013e3283653fd1
  11. Anastasiadis K, Asteriou C, Deliopoulos A, Argiriadou H, Karapanagiotidis G, Antonitsis P, Grosomanidis V, Misias G, Papakonstantinou C. Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures. Perfusion. 2010;25(4):197-203. https://doi.org/10.1177/0267659110373840
  12. Babliak O, Demianenko V, Melnyk Y, Revenko K, Pidgayna L, Stohov O. Complete Coronary Revascularization via Left Anterior Thoracotomy. Innovations (Phila). 2019;14(4):330-41. https://doi.org/10.1177/1556984519849126
  13. Babliak O, Demianenko V, Melnyk Y, Revenko K, Pidgayna L, Stohov O. Total coronary revascularization via left anterior thoracotomy: Practical aspects. Multimed Man Cardiothorac Surg. 2019;2019. https://doi.org/10.1510/mmcts.2019.031
  14. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16(1):9-13. https://doi.org/10.1016/s1010-7940(99)00134-7
  15. Hammermeister KE, Burchfiel C, Johnson R, Grover FL. Identification of patients at greatest risk for developing major complications at cardiac surgery. Circulation. 1990;82(5 Suppl):380-9.
  16. Baishya J, George A, Krishnamoorthy J, Muniraju G, Chakravarthy M. Minimally invasive compared toconventional approach for coronary artery bypass grafting improves outcome. Ann Card Anaesth. 2017;20(1):57-60. https://doi.org/10.4103/0971-9784.197837
  17. van Mastrigt GA, Heijmans J, Severens JL, Fransen EJ, Roekaerts P, Voss G, Maessen JG. Short-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness. Crit Care Med. 2006;34(1):65-75. https://doi.org/10.1097/01.ccm.0000191266.72652.fa
  18. Bucerius J, Gummert JF, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW. Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med. 2004;30(1):88-95. https://doi.org/10.1007/s00134-003-1950-5
  19. Heimrath OP, Buth KJ, Légaré JF. Long-term outcomes in patients requiring stay of more than 48 hours in the intensive care unit following coronary bypass surgery. J Crit Care. 2007;22(2):153-8. https://doi.org/10.1016/j.jcrc.2006.09.009
  20. Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg. 2006;81(3):880-5. https://doi.org/10.1016/j.athoracsur.2005.09.077
  21. Doering LV, Esmailian F, Imperial-Perez F, Monsein S. Determinants of intensive care unit length of stay after coronary artery bypass graft surgery. Heart Lung. 2001;30(1):9-17. https://doi.org/10.1067/mhl.2001.112502
  22. De Cocker J, Messaoudi N, Stockman BA, Bossaert LL, Rodrigus IE. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg. 2011 Jan;39(1):60-7. https://doi.org/10.1016/j.ejcts.2010.04.015
  23. Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res. 2016;16:318. https://doi.org/10.1186/s12913-016-1591-3
  24. Bashour CA, Yared JP, Ryan TA, Rady MY, Mascha E, Leventhal MJ, Starr NJ. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med. 2000;28(12):3847-53. https://doi.org/10.1097/00003246-200012000-00018
  25. Poston RS, Tran R, Collins M, Reynolds M, Connerney I,Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008;248(4):638-46. https://doi.org/10.1097/SLA.0b013e31818a15b5
  26. García-Delgado M, Navarrete-Sánchez I, Colmenero M. Preventing and managing perioperative pulmonary complications following cardiac surgery. Curr Opin Anaesthesiol. 2014;27(2):146-52. https://doi.org/10.1097/ACO.0000000000000059
  27. Naughton C, Reilly N, Powroznyk A, Aps C, Hunt T, Hunter D, Parsons RS, Sherry E, Spackman D, Wielogorski A, Feneck RO. Factors determining the duration of tracheal intubation in cardiac surgery: a single-centre sequential patient audit. Eur J Anaesthesiol. 2003;20(3):225-33. https://doi.org/10.1017/s0265021503000383
  28. Sato M, Suenaga E, Koga S, Matsuyama S, Kawasaki H, Maki F. Early tracheal extubation after on-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2009;15(4):239-42. PMID: 19763055.
  29. Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 5123 cardiac surgical patients. Eur J Anaesthesiol. 2009;26(5):396-403. https://doi.org/10.1097/EJA.0b013e3283232c69
  30. Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 3,269 CABG patients. Minerva Anestesiol. 2007;73(12):615-21. PMID: 18046291
  31. Lichtenberg A, Hagl C, Harringer W, Klima U, Haverich A. Effects of minimal invasive coronary artery bypass on pulmonary function and postoperative pain. Ann Thorac Surg. 2000;70(2):461-5. https://doi.org/10.1016/s0003-4975(00)01505-8
  32. McSweeney ME, Garwood S, Levin J, Marino MR, Wang SX, Kardatzke D, Mangano DT, Wolman RL; Investigatorsof the Ischemia Research and Education Foundation and the Multicenter Study of Perioperative Ischemia Research Group. Adverse gastrointestinal complications after cardiopulmonary bypass: can outcome be predicted from preoperative risk factors? Anesth Analg. 2004;98(6):1610-7. https://doi.org/10.1213/01.ANE.0000113556.40345.2E
  33. Tunç M, Şahutoğlu C, Karaca N, Kocabaş S, Aşkar FZ. Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery in Adults. Turk J Anaesthesiol Reanim. 2018;46(4):283-91. https://doi.org/10.5152/TJAR.2018.92244
Published
2021-12-22
How to Cite
Erdogan, E., Gokarslan, G., Uygur, F., Yardımcı, M., Kaya, E., & Sariguney, D. (2021). Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study. Ukrainian Journal of Cardiovascular Surgery, (4 (45), 30-35. https://doi.org/10.30702/ujcvs/21.4512/EG054-3035