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

• Published in: Intensive care medicine 2001-03, Vol.27 (3), p.534-539
• Main Authors: KILGER, E, WEIS, F. C, PETER, K, GOETZ, A. E, FREY, L, KESEL, K, SCHÜTZ, A, LAMM, P, ÜBERFUHR, P, KNOLL, A, FELBINGER, T. W
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty; APACHE; Biological and medical sciences; Blood Transfusion - statistics & numerical data; Cardiac arrhythmia; Cardiopulmonary Bypass - adverse effects; Cardiovascular disease; Catecholamines; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Disease - blood; Coronary Disease - enzymology; Coronary Disease - surgery; Coronary vessels; Critical Care - methods; Critical Care - standards; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Enzymes; Female; Heart attacks; Heart surgery; Hospitals; Humans; Intensive care; Intensive care medicine; Lactic Acid - blood; Length of stay; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Observational studies; Ostomy; Physiology; Postoperative Care - methods; Postoperative Care - standards; Postoperative period; Prospective Studies; Respiration, Artificial - statistics & numerical data; Time Factors; Treatment Outcome; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340000788

The purpose of this study was to compare the intensive care course of patients after minimally invasive coronary surgery to conventional coronary artery bypass grafting. Prospective observational study. Intensive care unit of a university hospital. One hundred and five patients with two-vessel disease consecutively scheduled for elective coronary bypass surgery were enrolled. Two techniques of revascularization were performed: the Octopus procedure via median sternotomy without cardiopulmonary bypass (n = 52) and conventional coronary artery bypass grafting CABG (n = 53). Three major categories describing the patients' postoperative course were defined: (1) clinical and laboratory findings, i.e., transfusion rate, catecholamine support, duration of ventilation, Simplified Acute Physiology Score II (SAPS II), serum levels of cardiac enzymes and lactic acid; (2) postoperative complications, i.e., incidence of myocardial 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 the ICU and in the hospital. In the Octopus group significantly lower figures were noted for duration of ventilation [6.1(5.5/9.5) vs 10.2(8.2/11.8) h], cardiac enzymes (CK-MB-Mass [5.1(2.0/8.3) vs 31.3(21.4/39.3) ng/ml], 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) vs 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 incidence of MI of each group did not differ significantly. Off-pump coronary surgery via the Octopus technique was superior to conventional CABG regarding the course of patients in the early postoperative period. This implies benefits for the patients and the entire healthcare system.