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J Thorac Cardiovasc Surg 1998;116:584-589
© 1998 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

PREOPERATIVE RISK MODELS FOR MINIMALLY INVASIVE CORONARY BYPASS: A PRELIMINARY STUDY

Pittsburgh, Pa

From the Divisions of Cardiothoracic Surgery, Cardiology, Critical Care Medicine, and Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Presented in part at the Seventieth Scientific Sessions of the American Heart Association, Orlando, Fla, Nov 9-12, 1997.

Received for publication March 3, 1998. Revisions requested May 26, 1998; revisions received June 23, 1998. Accepted for publication June 24, 1998. Address for reprints: Marco Zenati, MD, Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite C-700, Pittsburgh PA 15213-2582.

Objective:Available risk assessment models are designed for standard coronary artery bypass grafting. We hypothesized that minimally invasive coronary bypass could improve on predicted outcome in extremely high-risk patients (Parsonnet score > 20%) by the current risk models.
Methods: From September 1996 to September 1997, 27 consecutive extremely high-risk patients underwent minimally invasive coronary bypass. Seventeen patients were male; age was 73 ± 12 years, and 63% of patients were older than 75 years. Left ventricular ejection fraction was 33.7% ± 15% and 63% had an ejection fraction of less than 35%. The predicted 30-day mortality according to the System 97 model was 25.6% ± 11.3%. The Parsonnet risk score was 36.2% ± 11%; the predicted length of stay in the hospital was 15.3 ± 3 days. The predicted risk of stroke according to the Multicenter Perioperative Stroke Risk Index was 22.3% ± 11.7%.
Results: Minimally invasive coronary bypass was isolated in 20 patients and integrated with angioplasty and stenting in 7 patients. The observed 30-day mortality was 0% (P < .01 vs predicted): at an average follow-up of 10.8 ± 4.1 months, 26 patients (96.3%) are alive without angina; one patient with acquired immunodeficiency syndrome died on postoperative day 40 of acute pancreatitis. No patient had a stroke or neurologic deficit (P < .01 vs predicted). Patency of internal thoracic artery anastomosis was confirmed by angiography in all 27 patients. No patient required reoperation. Eighteen patients (67%) were extubated in the operating room. The observed length of hospital stay after minimally invasive coronary bypass was 3.8 ± 2.6 days (P < .01 vs predicted).
Conclusion: On the basis of our results on a relatively small series of patients, we suggest that risk models geared for standard coronary bypass grafting may not be appropriate for minimally invasive coronary bypass.

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