Intensive care after minimally invasive and conventional coronary surgery:a prospective comparison

Objective: The purpose of this study was to compare the intensive care cour se of patients after minimally invasive coronary surgery to conventional co ronary artery bypass grafting. Design: Prospective observational study. Setting: Intensive care unit of a university hospital. Patients and participants: One hundred and five patients with two-vessel di sease consecutively scheduled for elective coronary bypass surgery were enr olled. Interventions: Two techniques of revascularization were performed: the Octo pus procedure via median sternotomy without cardiopulmonary bypass (n = 52) and conventional coronary artery bypass grafting CABG (n = 53). Measurements and results: Three major categories describing the patients' p ostoperative course were defined: (1) clinical and laboratory findings, i.e ., transfusion rate, catecholamine support, duration of ventilation, Simpli fied Acute Physiology Score II (SAPS II), serum levels of cardiac enzymes a nd lactic acid; (2) postoperative complications, i.e., incidence of myocard ial infarction (MI), atrial fibrillation (AF), and neurological deficits; ( 3) this category was defined as "the extent of care" as represented by the Therapeutic Intervention Scoring System (TISS), and the length of stay in t he ICU and in the hospital. In the Octopus group significantly lower figure s were noted for duration of ventilation [6.1(5.5/9.5) vs 10.2(8.2/11.8) hi , cardiac enzymes {CK-MB-Mass [5.1(2.0/8.3) vs 31.3(21.4/39.3) ng/ mi], and lactic acid [2.0(1.5/3.3) vs 3.2(2.2/6.5) mmol/l]}, incidence of AF (2/52 vs 9/53), and neurological deficits (0/52 vs 4/53), TISS score [72(44/83) v s 84(73/93)], LOS in the ICU [2(1/2) vs 2(2/2) days], and in the hospital [ 6(5/9) vs 9(8/12) days]. Catecholamine support, SAPS II scores, and inciden ce of MI of each group did not differ significantly. Conclusions: Off-pump coronary surgery via the Octopus technique was superi or to conventional CABG regarding the course of patients in the early posto perative period. This implies benefits for the patients and the entire heal thcare system.