Port-access minimally invasive cardiac surgery increases surgical complexity, increases operating room time, and facilitates early postoperative hospital discharge

Background: Proposed advantages of port-access cardiac surgery have yet to be substantiated. The authors retrospectively compared patients undergoing port-access cardiac surgery with a matched group undergoing conventional ca rdiac surgery. Methods: Forty-six patients who underwent port-access cardiac surgery were matched with 46 who underwent conventional cardiac surgery. Absolute criter ia for matching included morning-of-surgery admission, procedure undergone, and care being delivered by one of two surgeons. If possible, matching inc luded care delivered by one of two anesthesiologists. Patients were matched as closely as possible for preoperative demographic and clinical character istics. Results: All 46 pairs of patients were matched for procedure and admitted t he morning of surgery. All 92 operations were performed by one of two surge ons, and 89% were performed by one of two anesthesiologists. Preoperative d emographic and clinical characteristics were equivalent between groups. Com pared with conventional cardiac surgery, port-access cardiac surgery increa sed surgical complexity (it almost tripled cardiopulmonary bypass time duri ng coronary artery bypass grafting and increased it almost 40% during mitra l valve procedures) and increased total operating room time (P < 0.0001). P ort-access cardiac: surgery had no beneficial effect on earlier postoperati ve extubation, decreased incidence of atrial fibrillation, or intensive car e unit time, yet it decreased postoperative duration of stay (P = 0.029, al l patients), a benefit observed primarily in patients undergoing coronary a rtery bypass grafting (P = 0.002). Conclusions: This retrospective analysis revealed that port-access cardiac surgery increases surgical complexity, increases operating roam time, has n o effect on earlier postoperative extubation or decreased incidence of atri al fibrillation or intensive care unit time, and may facilitate postoperati ve hospital discharge (primarily in patients undergoing coronary artery byp ass grafting). Properly designed prospective investigation is necessary to ascertain whether port-access cardiac surgery truly offers a:ny benefits ov er conventional cardiac surgery.