Rapid Recovery After Full Sternotomy Off-Pump Coronary Artery Bypass Grafting in Complex Cases: A Report of 3 Cases.

Abstract

BACKGROUND While very early discharge at 4 or fewer days after coronary artery bypass grafting (CABG) is proven safe, cost-effective, and not novel, the term "rapid discharge" to indicate discharge at 2 or fewer days has been put forth more recently. However, there have been no such discharges documented in certain complex and challenging clinical scenarios, such as in patients with solitary kidney with deranged renal function, in emergency settings, or in very severe left ventricular dysfunction and dense adhesive pericarditis with diffuse plaque necessitating coronary artery endarterectomy. CASE REPORT I present 3 cases of off-pump coronary artery bypass grafting (OPCAB) performed through conventional full sternotomy that were successfully discharged on the second postoperative day (at 42 h after surgery) in the following clinical settings: (1) patient with solitary kidney with borderline renal function; (2) patient undergoing emergency CABG; and (3) patient with adhesive pericarditis and severe left ventricular dysfunction requiring concomitant coronary endarterectomy with pericardiectomy. Such successful rapid discharges have never been documented in the medical literature so far. None of the patients required hospital readmissions, and all 3 patients have completed 12 months of successful follow-up. CONCLUSIONS Enhanced recovery after cardiac surgery (ERACS) can possibly be expanded safely and successfully to several clinical subsets of patients with multiple risk factors and a higher degree of surgical complexity.