Ms. Dickes et al., Outcome analysis of coronary artery bypass grafting: minimally invasive versus standard techniques, PERFUSION-U, 14(6), 1999, pp. 461-472
Minimally invasive coronary artery bypass grafting (MIDCAB) procedures are
purported to result in improvements in patient management over standard tec
hniques. A comparative study was performed on risk-stratified patients trea
ted with either technique. Following institutional review board approval. a
retrospective random chart review was conducted on 27 MIDCAB and 37 standa
rd coronary artery bypass grafting (CABG) patients who were operated on ove
r a 12-month period at the University of Nebraska Medical Center. Risk stra
tification was accomplished by dividing the two patient populations. MIDCAB
and 'standard', into one of four subgroups based on a preoperative risk sc
ore. Risk stratification was achieved by dividing the patient populations i
nto one of four subgroups: good, fair poor and high risk. Both groups recei
ved similar operations and surgical interventions, except for the inclusion
of cardiopulmonary bypass (CPB). Approximately 200 parameters were collect
ed and analyzed in the following categories: anthropometric, operative and
postoperative outcomes.
The MIDCAB group had a significantly lower number of vessels bypassed (2.0
+/- 0.7 vs 3.4 +/- 0.9. p < 0.0001). Total postoperative blood product tran
sfusions trended higher in the standard group (6.1 +/- 12.6 U) when compare
d to the MIDCAB patients (2.3 +/- 5.5 U, p +/- 0.15). although not statisti
cally significant. Postoperative inotrope use was significantly less in the
MIDCAB group (19% vs 59%, p < 0.002). Ventilator time in the MIDCAB group
was 10.5 +/- 5.4 h vs 15.0 +/- 12.3 h in the standard group (p < 0.07). The
MIDCAB group had an overall greater length of stay, but was only statistic
ally different within the poor-risk subgroup (12.2 +/- 10.7 vs 7.5 +/- 3.9.
p < 0.04).
The results of this study show that when CPB is not utilized in treating pa
tients undergoing CABG procedures, the benefits in regards to patient outco
mes are unclear. This necessitates the need for further work when comparing
outcomes for risk-stratified patients.