A Prophylactic Noninvasive Ventilation Reduces Complications Following Minimally Invasive Coronary Surgery

Objective: Postoperative pulmonary complications (PPCs) remain a significant source of morbidity and mortality in patients undergoing minimally invasive cardiothoracic procedures. Noninvasive ventilation (NIV) is frequently employed as adjunctive therapy to manage respiratory insufficiency. This study evaluated the implementation of prophylactic NIV immediately following extubation after minimally invasive direct coronary artery bypass (MIDCAB) surgery. Methods: A total of 454 consecutive patients undergoing MIDCAB were included. In total, 139 patients received prophylactic NIV (P-NIV)-postoperative management, 315 patients formed a historical control group treated according to the previous standard of care. Clinical outcomes assessed postoperative pulmonary complications, in-hospital mortality, and one-year survival. Results: The incidence of PPCs was significantly lower in the P-NIV group compared with the control cohort (6.5% vs. 14.9%; p = 0.012). Unadjusted analyses demonstrated a significant reduction in the odds of PPCs with P-NIV (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.17-0.85). Using inverse probability of treatment weighting, prophylactic NIV was associated with an absolute reduction of 8.0 percentage points in PPC risk across the entire cohort (average treatment effect [ATE], -0.080; 95% CI, -0.136 to -0.024; z = -2.80; p = 0.005). Kaplan-Meier analysis demonstrated significantly improved one-year survival in the P-NIV group (log-rank p = 0.047). Conclusions: The implementation of prophylactic NIV following MIDCAB was associated with a greater than 50% reduction in the odds of PPCs in both unadjusted and adjusted analyses and improved one-year survival. These results support the adoption of routine prophylactic NIV in the postoperative management of patients undergoing minimally invasive coronary surgery.