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Outcomes after Minimally Invasive Coronary Artery Bypass Grafting at a Community-based Hospital
Prem Rabindranauth, Kara J. Kallies.
Gundersen Health System, La Crosse, WI, USA.

OBJECTIVE: Minimally invasive coronary artery bypass grafting (MICS CABG) via left mini-thoracotomy is an acceptable alternative to conventional CABG via sternotomy. Our objective was to review patient outcomes after MICS CABG performed at our community-based hospital.
METHODS: A retrospective review of the medical records of all patients who underwent MICS CABG from December 2009 through December 2016 was completed.
RESULTS: Overall, 338 patients underwent MICS CABG; 23 of whom had a planned hybrid MICS CABG and PCI performed. Six cases were performed concurrent with an additional procedure requiring bilateral thoracotomies (4 mitral valve repair, 2 radiofrequency ablation). The mean age and BMI was 67.110.6 years and 30.018.1 kg/m2; 77% were male. When broken down by quartile, a decrease in mean operative time (Q1=233, Q2=210, Q3=206, Q4=191 minutes) and an increase in single vessel LIMA-LAD case volume (Q1=31%, Q2=38%, Q3=39%, Q4=40%) was observed. Two patients were converted to sternotomy and 61% were extubated in the operating room. Median postoperative length of stay was 4 (2-31) days. Thirty-day complications included stroke (1.5%), pleural effusion requiring thoracentesis (2.4%), and new-onset atrial fibrillation/flutter (15.7%). There were 5 (1.5%) mortalities. The mean follow-up duration was 3.02.2 years. Re-interventions included PCI and re-do CABG (Table).
CONCLUSIONS: MICS CABG continues to provide a viable alternative to CABG via sternotomy. Patient morbidity and mortality and re-intervention rates after MICS CABG at our community medical center were comparable to those reported in the Society of Thoracic Surgeons national database. The role of hybrid revascularization warrants further study.

Re-interventions after MICS CABG.
Postoperative intervalNIntervention, n (%)Readmission, n (%)
Cardiac catheterization*PCI*Re-do CABG
≤30 days3114 (1.3)1 (0.3)023 (7.4)
31-90 days2796 (2.2)4 (1.4)1 (0.4)16 (5.7)
91 days - 1 year24917 (6.8)9 (3.6)015 (6.0)
> 1 year20428 (13.7)13 (6.4)1 (0.5)8 (3.9)
*excludes 23 planned hybrid MICS CABG/PCI cases. N excludes patients who were lost to follow-up.

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Endorsed by:
The Society of Thoracic Surgeons

Co-sponsored by:
Association of Physician Assistants in Cardiovascular Surgery (APACVS) The International Society for Minimally Invasive Cardiothoracic Surgery Japanese Association for Coronary Artery Surgery
Brazilian Society of Cardiovascular Surgery Fu-Wai Hospital of Beijing Indian Association of Cardiovascular-Thoracic Surgeons
Society for Cardiothoracic Surgery in Great Britain & Ireland