Minimally invasive technique facilitates early extubation after cardiac surgery: a single-center retrospective study

• Published in: BMC anesthesiology Vol. 24; no. 1; pp. 1 - 15
• Main Authors: Tang, Siyu, Qu, Yan, Jiang, Huan, Cai, Hanhui, Zhang, Run, Hong, Jun, Zheng, Zihao, Yang, Xianghong, Liu, Jingquan
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 07.09.2024; BioMed Central; BMC
• Subjects: Body mass index; Cardiac arrhythmia; Cardiac patients; Cardiomyopathy; Cardiovascular disease; Classification; Comparative analysis; Complications; Conventional median sternotomy; Coronary vessels; Endocarditis; Extubation; Heart; Heart surgery; Heart valve surgery; Intensive care; Length of stay; Mechanical properties; Mechanical ventilation; Medical care, Cost of; Methods; Mortality; Patients; Pleural effusion; Pneumonia; Postoperative; Prognosis; Review boards; Surgery; Thoracoscopy; Vein & artery diseases; Ventilators; China
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-024-02710-7

Background Postoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation. Methods Data from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People's Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan-Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed. Results After propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01). Conclusions Successful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate. Keywords: Thoracoscopy, Conventional median sternotomy, Heart valve surgery, Mechanical ventilation, Extubation, Intensive care