A Clinical Study Of Minimally Invasive Direct Coronary Artery Bypass Procedure

Objective:Minimally invasive cardiac surgery has dramatically developed for the past 10 years. Institutional experiences with good outcomes have been reported. This study compares minimally invasive technique through a lower median ministernotomy with conventional sternotomy in coronary artery bypass surgery. We summarize our experience at the same time.Methods:From January 2014 to January 2015, 41 patients, who needed to undertake a coronary artery bypass surgery for CAD, NYHA class I-III and no history of cardiothoracic surgery, were selected in this study. Patients with valvular disease were excluded. According to the principle of random and opinions of the patients and their families, they were divided into 2 groups by different surgical approaches. Group A( n = 21) received a lower median ministernotomy OPCAB while Group B( n = 20) underwent conventional sternotomy OPCAB. We collected clinical indicators of the two groups including before operation in general( patients in age, weight, NYHA, LV-EF, myocardial enzyme(CK, CK-MB, LDH), c Tn I, NT-pro BNP, coronary angiography), in operation(The length of the incision, the harvesting time of IMA, the vascular anastomosis time, the total operation time, blood transfusion, etc.) and post operation(the ventilation time, ICU time, hospital stay, drainage, the recovery of cardiopulmonary function including respiratory index, cardiac index, NT-pro BNP and LV-EF, myocardial enzyme(CK, CK-MB, LDH), c Tn I, pain intensity).Results:There was no hospital mortality in either group. Low cardiac output syndrome, respiratory complications and central nervous system complications were not observed. There was no reoperation for bleeding. 1 case had to convert into conventional sternotomy in Group A. There were no statistical differences in age, weight, NYHA, preoperative LV-EF, LV, the harvesting time of IMA, vascular anastomosis time, blood transfusion. Operation time in Group A was shorter than in Group B(152.85±13.08 min VS 187.38±19.79 min P<0.05). Chest drainage in Group A were observed less than in Group B(233.33±28.84 ml VS376.24±33.60 ml P<0.05)in the first day after operation. 12 Patients(60%) in Group A had no blood transfusion at all versus 10 patients(40%)in Group B. Mechanical ventilation time, postoperative ICU time and hospital stay were shorter(13.55±2.93 h VS17.28±4.59 h P= 0.004; 86.78±7.85 h VS 114.26±26.56 h P < 0.05; 11.05±2.37 d VS 13.05±2.56 d P=0.013). The review of echocardiography showed that the two groups of postoperative Lv EF turned for the better. But there was no statistically significant difference between two groups(P > 0.05).NT-pro BNP was highest at the 2th day postoperatively. NT-pro BNP of 7th day was on a declining curve, compare with that of 2th day postoperatively. In the postoperative myocardial enzyme of the two groups, CK and LDH increased significantly and reached the highest in 24h(398.5±102.43 VS 581.38±78.18 P<0.05;421.70±84.73 VS 634.33±74.17 P<0.05). And there existed significant difference between the two groups in this point. The average of CK and LDH in other point of minimally invasive group is lower than the control group, but there was no statistically significant difference. CK-MB increased also. But in each time point there was no statistically significant difference between the two groups. Troponin within 24 hours arrived the highest, but at all time points of the two groups there was no statistically significant difference. There were no differences in RI,CI(1h,2h,4h,8h,24h). Pain intensity within 3 days in Group A had a definitely faster rising degree than that in Group B. The median incision length was obviously shorter in Group A than that in Group B(11.36±1.54 cm VS 22.87±1.82 cm P < 0.05). All patients had no wound infection and were satisfied with the minimally invasive cardiac surgery(MICS).Conclusions:Minimally invasive cardiac surgery with lower median ministernotomy is a safe and reliable, with fewer traumas, less cost, good cosmetic results and similarly clinical results compared with sternotomy surgery.