Minimally invasive coronary bypass: optimised performance after a learningperiod

Minimally invasive cardiac surgery requires a learning period before the ad vantages of the method can be demonstrated. We report the progress of our r esults over 21 consecutive months. 27 patients were considered for minimally invasive coronary bypass via a sm all thoracotomy We compare the results of four consecutive groups correspon ding to an initial period (July-December 1997; n = 7; 66.8 +/- 8.9 years), an intermediate period (January-June 1998; n = 4; 48.1 +/- 11.2 years), an advanced period (July-December 1998; n = 7; 62.9 +/- 7.0 years) and a curre nt period (January-March 1999; n = 7; 59.3 +/- 10.9 years). 2 patients were converted to sternotomy during the first year of experience. The operating time was reduced from 124 +/- 14 min and 118 +/- 20 min during the initial and intermediate periods to 99 +/- 18 and 98 +/- 16 min during the last tw o periods. The ICU stay was 2.6 +/- 1.1 days during the initial period and diminished respectively to 1.5 +/- 0.6, 1.7 +/- 0.8 and 1.6 +/- 0.5 days du ring the intermediate, advanced and current periods. The postoperative hosp ital stay was reduced from 9.0 +/- 1.4 days to 6.3 +/- 4.6, 5.2 +/- 1.7 and 5.9 +/-: 1.5 days respectively. The benefits of minimally invasive coronary bypass were estimated by compar ing the results of the last two periods with those of patients operated on through a sternotomy, an a beating heart (n = 12; 62.6 +/- 8.2) or under CP B (n = 81; 63.0 +/- 8.5). In these situations, operative time was 144 +/- 4 1 min and 180 +/- 35 min respectively. The ICU stay was 1.5 +/- 0.6 and 2.2 +/- 0.9 days, and the postoperative hospital stay was 7.5 +/- 2.8 and 8.6 +/- 3.0 days. We conclude that a learning period is necessary before the real benefits of the minimally invasive approach to coronary disease can be demonstrated. T his method will soon replace traditional sternotomy in certain indications.