Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease: A Prospective Longitudinal Study

Abstract

Introduction: Minimally invasive coronary artery bypass grafting has been predominantly used in single vessel coronary artery disease and is gaining wider acceptance over the conventional approach. Minimally invasive surgery for multivessel coronary disease is still restricted to fewer centres due to its technical difficulty and longer learning curve. Aim: To evaluate patients who underwent minimally invasive coronary artery bypass grafting surgery for multi-vessel coronary artery disease. Materials and Methods: Forty three patients underwent minimally invasive beating heart coronary artery bypass grafting surgery for multi-vessel coronary artery disease. Data was analysed with inferential and descriptive statistics. Continuous or interval based variables were expressed as mean±standard deviation. Postoperative Visual Analogue Scoring (VAS) of pain (1-10) was recorded on day 1 and day 2 after surgery. They were compared using paired one-tail student t-test. Results: The mean age of 43 patients was 57.88±7.91 years. Thirty three patients received two grafts. Ten patients received 3 grafts. The mean duration of ventilation was 8±3.3 hours. The length of intensive care unit stay ranged from 1 day to 3 days with a mean of 2.23±0.57 days. The mean VAS score of pain on postoperative day 1 was 3.93±2.23. It significantly reduced to 1.67±1.43 on day 2 (p<0.05). The duration of hospital stay ranged from 5 days to 18 days with a mean of 9.5±2.7 days. The duration required for the patient to resume routine physical activities was 10.35±9.13 days. Conclusion: Minimally invasive coronary artery bypass grafting surgery through left anterior thoracotomy approach can be done safely for multi-vessel coronary artery disease with good and acceptable postoperative outcomes. There is a significant reduction of pain by second postoperative day. Three-fourth of the patients resumed routine physical activity within 12 days of surgery.

Keywords

• pain
• sternotomy
• thoracotomy