Fast-Track Extubation in the Operating Room After Minimally Invasive Direct Coronary Artery Bypass Grafting

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-07-24 DOI:10.1155/jocs/9180245

Sebastian Johannes Bauer, Tomoyuki Suzuki, Yukiharu Sugimura, Anna Fischbach, Ajay Moza, Arash Mehdiani, Evangelos Karasimos, Gereon Schaelte, Rolf Rossaint, Gernot Marx, Payam Akhyari

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引用次数: 0

Abstract

Introduction: Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers a less traumatic alternative to conventional median sternotomy. The benefits of avoiding sternotomy align with the goals of enhanced recovery after surgery (ERAS). While early extubation benefits have been demonstrated in conventional CABG, evidence on extubation in the operating room remains scarce. We present a single-center experience with immediate extubation outside of a structured ERAS concept.

Methods: Patients undergoing MIDCAB via a left anterolateral thoracotomy with unilateral ventilation between August 2022 and March 2024 were retrospectively analyzed. Patients who were extubated in the operating room (extubation in tabula, EIT) were compared to those who were extubated in the intensive care unit (ICU) (control, CTRL). The primary outcome was a transfer to general ward within 24 h after admission to ICU. Secondary outcomes aimed to assess safety endpoints, including the rate of reintubation, major adverse cardiac and cerebrovascular events, and length of stays.

Results: A total of n = 79 patients were included. After propensity score matching, the cohorts consisted of n = 20 (CTRL) and n = 35 (EIT) patients, who had a median age of 68 years (IQR: 63–75), were 83.6% male, and showed comparable baseline characteristics. The majority of patients (92.7%) underwent single arterial bypass grafting. Fifteen patients (27.3%) met the primary endpoint with no significant difference between the two cohorts (CTRL 20.0%, EIT 31.4%, p = 0.531). Three patients in the EIT cohort required reintubation due to revision surgery (n = 2) and cardiopulmonary resuscitation (n = 1) due to thrombotic ischemia. The median stay in ICU was 23 h (IQR: 18–28), the total length of hospital stay 6d (IQR: 5–8) respectively.

Conclusion: EIT after MIDCAB is safe and feasible. However, on its own, it does not affect subsequent transfers and should therefore be only considered as the first step toward a comprehensive ERAS approach.

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微创直接冠状动脉旁路移植术后快速通道拔管

简介：微创直接冠状动脉旁路移植术（MIDCAB）提供了一种创伤较小的替代传统胸骨正中切开术。避免胸骨切开术的好处与提高术后恢复（ERAS）的目标一致。虽然传统冠状动脉搭桥的早期拔管益处已被证明，但在手术室拔管的证据仍然很少。我们提出了在结构化ERAS概念之外的立即拔管的单中心体验。方法：回顾性分析2022年8月至2024年3月间经左前外侧开胸单侧通气行MIDCAB的患者。将在手术室拔管的患者（tabula拔管，EIT）与在重症监护病房拔管的患者（control， CTRL）进行比较。主要结局是在入住ICU后24小时内转至普通病房。次要结局旨在评估安全性终点，包括再插管率、主要心脑血管不良事件和住院时间。结果：共纳入n = 79例患者。倾向评分匹配后，队列由n = 20 （CTRL）和n = 35 （EIT）患者组成，中位年龄为68岁（IQR: 63-75），男性占83.6%，具有可比较的基线特征。大多数患者（92.7%）行单动脉旁路移植术。15例患者（27.3%）达到主要终点，两组间无显著差异（CTRL为20.0%，EIT为31.4%,p = 0.531）。EIT队列中有3例患者因翻修手术需要重新插管（n = 2），因血栓性缺血需要心肺复苏（n = 1）。ICU中位住院时间23 h (IQR: 18 ~ 28)，总住院时间6d （IQR: 5 ~ 8）。结论：MIDCAB术后EIT是安全可行的。但是，就其本身而言，它并不影响其后的转让，因此只应被视为迈向全面的ERAS办法的第一步。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.