MINIMALLY INVASIVE HEART SURGERY RESULTS
Category: Cardiovascular Surgery
Abstract :
Aftercare The patient receives continued cardiac monitoring in the intensive care unit. Once the patient is able to breathe on his/her own, the breathing tube is removed (extubation), if it is not removed immediately post-operatively. Any medications to treat poor cardiac function or manage blood pressure are discontinued as cardiac function improves and blood pressure stabilizes. Blood draina
Aftercare
The patient receives continued cardiac monitoring in the intensive care unit. Once the patient is able to breathe on his/her own, the breathing tube is removed (extubation), if it is not removed immediately post-operatively. Any medications to treat poor cardiac function or manage blood pressure are discontinued as cardiac function improves and blood pressure stabilizes.
Blood drainage tubes protruding from the chest cavity are removed once internal bleeding decreases. The patient also may be equipped with external cardiac pacing to maintain heart rate. The pacing is terminated once the heart is beating at an adequate rate free of arrhythmia. A warming blanket may be used to warm the patient’s core temperature that was decreased by the surgical exposure.
The duration of the post-operative hospital stay is reduced by one to two days in these procedures. Pain also should be reduced. Homecare for the wound is described prior to discharge, and instructions for responding to adverse events after discharge also are given. Patients who have undergone these procedures should expect to return to normal activities sooner than those who have undergone traditional coronary artery bypass grafting.
Risks
MIDCAB can result in a higher rate of restenosis (recurrence of narrowing of the arteries) then traditional coronary artery bypass grafting, but these numbers continue to decrease as experience with the procedure improves. Some patients may have to have the procedure converted to a standard sternotomy with cardiopulmonary bypass, if the anastomosis can not be completed from the MIDCAB approach. Rib fracture is the most common adverse event. Pericarditis also is a possible complication. Supraventricular arrhythmias and ST segment elevation also may develop.
In the event of systemic blood pressure abnormalities, arrhythmia, poor surgical anastomosis, or poor exposure of the coronary blood vessels, OPCAB patients may require conversion to cardiopulmonary bypass for completion of the anastomosis. Post-operatively some patients may need additional surgery to control bleeding or to address poor sternal healing. This is related to the increased use of both internal mammary arteries for these procedures. Cerebral complications and atrial fibrillation also may be experienced. These post-operative complications are comparable to those seen in patients who have undergone traditional coronary artery bypass grafting.
Normal results
Patency (openess) of the grafted vessels is expected to be the same as what is seen in traditional coronary artery bypass grafting. When compared to traditional coronary artery bypass grafting, minimally invasive heart surgery also is expected to result in a shorter hospital stay, less pain, fewer blood transfusions, and quicker return to normal activity.
Morbidity and mortality rates
MIDCAB
Conversion to a full sternotomy or sternotomy with cardiopulmonary bypass is expected in 1–2% of patients. Redo procedures and reoperation can occur in over 5% of patients, which is still lower than the risk of a second procedure associated with balloon angioplasty and stent placement. Over 90% of all patients are expected to be free of adverse events. Complications most frequently involve rib fracture (over 10% of patients). Mortality associated with MICAB is low and is not seen during the surgical procedure in most instances, but is associated with post-operative complications.
OPCAB
Conversion to cardiopulmonary bypass may be required in patients if anastomosis cannot be completed due to unstable blood pressure, arrhythmia, ischemia, poor anastomosis, or poor surgical access. The same operative mortality is expected when compared to cardiopulmonary bypass patients. The expected decrease in neurological events, renal dysfunction, pulmonary complications, or arrhythmias has not yet been shown to be a consistent benefit, therefore all of these complications can still occur.
Alternatives
Percutaneous balloon angioplasty and coronary stenting of the left anterior descending artery are successful alternative procedures. MIDCAB may be a preferred treatment when compared to balloon angioplasty and stenting because fewer repeat interventions are required. An additional alternative is traditional on-pump, cardiopulmonary bypass; coronary artery bypass grafting is a powerful technique with a long record of safety and effectiveness since the 1960s.
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