MORBIDITY, COST, AND 6-MONTH OUTCOME OF MINIMALLY INVASIVE DIRECT CORONARY-ARTERY BYPASS-GRAFTING

Background. Minimally invasive direct coronary artery bypass grafting (MIDCABG) promises to reduce the morbidity of coronary bypass, but thi s has not been proved. Methods. This retrospective study compares the morbidity, mortality, cost, and 6-month outcome of patients less than 80 years old undergoing elective left internal mammary artery to left anterior descending artery bypass grafting via MIDCABG (n = 60) or ste rnotomy (n = 55) between January 1995 and December 1996. There were no differences between the groups in mean age, sex distribution, or preo perative risk level. The left internal mammary artery was mobilized fr om the fifth costal cartilage to the subclavian artery in all patients . The anastomoses were done with a beating heart in the MIDCABG group and with cardioplegic arrest in the sternotomy group. Results. There w ere no operative deaths in either group. The MIDCABG patients had a lo wer transfusion incidence (10/60 [17%] versus 22/55 [40%]; p less than or equal to 0.02) and a shorter postoperative intubation time (2.1 +/ - 4.2 versus 12.6 +/- 9 hours; p less than or equal to 0.0001). One pa tient in each group was reexplored for bleeding. Three sternotomy pati ents (3/55, 5%) required ventilatory support for greater than 48 hours , but no MIDCABG patient was ventilated for more than 24 hours. Median postoperative length of stay was 4 days for MIDCABG and 7 days for st ernotomy. Estimated hospital costs were $11,200 +/- 3100 for MIDCABG a nd $15,600 +/- 4200 for CABG (p < 0.001). The reduced morbidity and co st of MIDCABG was found mostly in high-risk patients. At 6-month follo w-up, 5 MIDCABG patients (5/60, 8%) had evidence of recurrent ischemia involving the left anterior descending artery, primarily the result o f anastomotic stricture. Conclusions. This analysis shows that MIDCABG reduces the initial morbidity and cost of coronary bypass, but some p atients require subsequent reintervention. Long-term follow-up is need ed before MIDCABG can be judged better than traditional bypass, but th e initial results are promising, especially in high-risk patients. (An n Thorac Surg 1998;66:1224-9) (C) 1998 by The Society of Thoracic Surg eons.