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Objective: To report our initial experience with a novel surgical revascularisation approach that permits effective regional anaesthesia and where appropriate early extubation and shortened ITU and hospital stay.
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Gavin J. Murphy, Raimondo Ascione, Gianni D. Angelini.
Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom.
Methods: Demographic, comorbid, operative and outcome data on 42 patients (median age 61 years (interquartile range (IQR) 55-71), 6/42 female (14%) that had undergone surgical revascularisation via a small left anterior thoracotomy between January and October 2006 were extracted from our institutional database (Patient Analysis & Tracking Systems: Dendrite Clinical Systems, London, UK). Twenty-one (50%) patients had triple vessel disease, 8/42 (19%) had left main stem disease, 38/42 (91%) had good left ventricular function and 19/42 (45%) were urgent cases. Median EuroSCORE was 2 (IQR 1-3). Grafts were performed using established beating heart techniques and postoperative anaesthesia was achieved by infusion of local anaesthetic via a paravertebral catheter.
Results: A median of 2 grafts were performed per patient (IQR 1-3). Eleven patients (26%) were successfully extubated on the operating table or immediately on return to the Intensive Care Unit (ICU). Median time to extubation was 5 hours (IQR 1-7). Median ICU stay was 1 day (IQR 1-1). Postoperative morbidity included haemodynamic support 19/42 (45%), myocardial infarction 0/42, atrial fibrillation 6/42 (14%), respiratory complication 7/42 (17%), reoperation 1/42 (2%) and leg wound infection 2/42 (5%). At six week follow-up one patient had died from disseminated malignancy, and all surviving patients were free of angina symptoms.
Conclusions: Complete revascularization on the beating heart through an anterolateral thoracotomy is safe and feasible in patients requiring coronary artery surgery. Shorter ventilation times may translate into shorter hospital stays and reduced hospitalisation costs for cardiac surgical patients.
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