Background: Pulmonary complications are among the main causes of increased mortality and morbidity,
prolonging ICU and hospital stay after cardiac surgery. Recently, a sternum-sparing
concept of minimally invasive total coronary revascularization via anterior minithoracotomy
(TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due
to the thoracic incision and length of surgery. Pulmonary complications in TCRAT were
compared with standard coronary artery bypass grafting (CABG) via full median sternotomy
(FS).
Methods: Records of 151 consecutive TCRAT (from 09/2021 to 11/2022) and 229 consecutive FS
(from 01/2017 to 12/2018) patients, who underwent elective or urgent CABG, were analyzed.
Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension,
COPD, smoking status, left ventricular ejection fraction, pulmonary hypertension,
EuroScore2) were comparable between groups.
Results:
Table 1 Results
|
TCRAT
|
FS
|
p-value
|
|
Length of ICU stay (days)Length of hospital stay (days)
|
2.4 ± 3.010.9 ± 8.5
|
1.8 ± 1.813.2 ± 9.3
|
<0.05<0.05
|
|
Ventilation time (min)
|
875 ± 665
|
920 ± 701
|
ns
|
|
Pneumonia (%)Atelectasis (%)Pleural effusion (%)
|
2.6%28.5%8.6%
|
3.0%24.9%3.5%
|
nsns<0.05
|
|
Bronchoscopy (%)Reintubation (%)Tracheotomy (%)
|
5.9%7.9%1.3%
|
1.7%7.0%0.4%
|
<0.05nsns
|
|
In-hospital mortality (%)
|
1.3%
|
1.7%
|
ns
|
Longer operation (347 ± 71 vs. 293 ± 72 min), cardiopulmonary bypass (169 ± 40 vs.
115 ± 35 min), and aortic cross-clamping (108 ± 33 vs. 74 ± 25 min) was associated
with longer ICU stay in TCRAT, while hospital stay was shorter.
Conclusion: Pulmonary complications in terms of pleural effusions were more common with TCRAT,
however, without substantial impact on clinical outcome.
