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Safety and cost-effectiveness of MIDCABG in high-risk CABG patients
D F Del Rizzo1, W D Boyd, R J Novick
1London Health Sciences Centre, University of Western Ontario, Canada. ddelrizzo@exchange.hsc.mb.ca
Insights
Minimally invasive direct coronary artery bypass grafting (MIDCAB) is a safe and cost-effective option for high-risk patients. This approach significantly reduces intensive care unit and hospital stays, offering substantial cost savings.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- High-Risk Patient Management
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- High-risk patients often face increased complications with conventional CABG.
- Myocardial revascularization without cardiopulmonary bypass is an emerging alternative for these patients.
Purpose of the Study:
- To compare the outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) versus conventional CABG in high-risk patients.
- To evaluate the safety, efficacy, and cost-effectiveness of MIDCAB in this population.
Main Methods:
- A comparative study involving 15 high-risk patients undergoing MIDCAB and 41 consecutive patients undergoing conventional CABG.
- Patient demographics and clinical characteristics were analyzed.
- Outcomes including mortality, intensive care unit (ICU) stay, hospital stay, and cost were assessed.
Main Results:
- No deaths occurred in the MIDCAB group compared to one death in the conventional CABG group.
- MIDCAB patients experienced significantly shorter predicted ICU and hospital stays than expected.
- MIDCAB resulted in an estimated 50% cost saving per patient compared to conventional CABG.
Conclusions:
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) is a safe and effective therapeutic option for high-risk patients.
- This approach demonstrates significant reductions in resource utilization and substantial cost-effectiveness.
Background:
Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month.
Methods:
Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 +/- 11.6 versus 63.3 +/- 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p < 0.0001; peripheral vascular disease, 33.3% versus 12.2%, p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0% versus 17.0%, p = 0.07; urgent operation, 86.6% versus 46.3%, p < 0.0001; and redo operation, 20.0% versus 0%, p = 0.003.
Results:
There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 +/- 0.5 days in HR patients versus 1.6 +/- 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 +/- 1.8 versus 7.3 +/- 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 +/- 1.2 days (versus the observed stay of 1.1 +/- 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 +/- 1.5 days (versus the observed stay of 6.1 +/- 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1% versus 0%, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%.
Conclusions:
Myocardial revascularization without cardiopulmonary bypass appears to be a safe and cost-effective therapeutic modality for HR patients requiring myocardial revascularization.