Safety and effectiveness of minimal-access versus conventional coronary artery bypass grafting in emergent patients

Myocardial revascularization with a minimal-access incision is used in many patients who undergo an elective coronary artery bypass grafting (CABG) operation. To evaluate whether this method could be used for patients who undergo an emergent CABG operation, we compared patients in whom emergent minimal-access CABG was used as the method of revascularization with patients who underwent emergent conventional CABG.

From June 1996 to April 1998, 63 patients underwent emergent CABG operation due to unstable angina, percutaneous transluminal coronary angioplasty accident, or critical left main lesion. Ten patients received minimal-access CABG via limited left parasternal incision (MI), and 53 patients received conventional CABG via median sternotomy (CS).

There were 2 deaths in the MI group and 13 deaths in the CS group. We used the Society of Thoracic Surgery computer program to predict the mortality of both groups. The expected hospital mortality of the MI group was significant higher than that of the CS group. The 24-hour drainage amount in the MI group was significant less than that of the CS group. There were no significant differences in cross-clamping time, the duration of extracorporeal circulation, the intensive care unit stay, or the average hospital stay. Total costs of the MI group were similar to those of the CS group, except that the blood transfusion fee was significantly lower (9,406 +/- 1,259 vs. 12,059+ 3,994 New Taiwan dollars, p = 0.003).

This technique combines minimally invasive surgical conditions with the safety and cost standards of emergent CABG surgery. Even emergent and high-risk coronary artery disease can be treated using this approach.