Comparison of Pulmonary Outcome in Minimally Invasive (TCRAT) and Full Sternotomy CABG

Abstract

Background: Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged 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 the longer duration of surgery. Pulmonary complications in TCRAT were compared to 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 patients (from 01/2017-12/2018) 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 hypertonus, EuroScore II) were comparable between groups. Results: Differences between examined groups examined were found for the pulmonary parameters Horowitz index 6 hours after operation (TCRAT 270±72 vs. FS 293±73, p<0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, p<0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, p<0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, p< 0.05). Moreover, there were differences between groups with regard to mean ICU-stay (TCRAT 2.4±3.0days vs. FS 1.8±1.8days, p<0.05), stroke (TCRAT 0% vs. FS 1.3%, p<0.05), and hospital stay (TCRAT 10.9±8.5days vs. FS 13.2±9.3days, p<0.05). There were no differences regarding atelectasis, re-intubations, tracheostomies, ventilation time, and mortality. Conclusion: Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.