Sellin Christian, Sand Ulrike, Demianenko Volodymyr, Schmitt Christoph, Schäfer Benedikt, Schier Robert, Doerge Hilmar
Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda gAG, Hessen, Germany.
Department of Anaesthesiology, Klinikum Fulda gAG, Fulda, Hessen, Germany.
Thorac Cardiovasc Surg. 2025 Apr;73(3):185-190. doi: 10.1055/a-2378-8459. Epub 2024 Aug 2.
Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due to the thoracic incision and the longer duration of surgery. Pulmonary complications in TCRAT were compared to standard coronary artery bypass grafting (CABG) via full median sternotomy (FS).
Records of 151 consecutive TCRAT (from September 2021 to November 2022) and 229 consecutive FS patients (from January 2017 to December 2018) patients, who underwent elective or urgent CABG, were analyzed. Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension, chronic obstructive pulmonary disease, smoking status, left ventricular ejection fraction, pulmonary hypertonus, and EuroScore II) were comparable between groups.
Differences between examined groups examined were found for the pulmonary parameters: Horowitz index 6 hours after operation (TCRAT 270 ± 72 vs. FS 293 ± 73, < 0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, < 0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, < 0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, < 0.05). Moreover, there were differences between groups with regard to mean ICU stay (TCRAT 2.4 ± 3.0 days vs. FS 1.8 ± 1.8 days, < 0.05), stroke (TCRAT 0% vs. FS 1.3%, < 0.05), and hospital stay (TCRAT 10.9 ± 8.5 days vs. FS 13.2 ± 9.3 days, < 0.05). There were no differences regarding atelectasis, reintubations, tracheostomies, ventilation time, and mortality.
Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.
肺部并发症是心脏手术后死亡率和发病率增加以及重症监护病房（ICU）和住院时间延长的主要原因之一。最近，引入了一种通过前侧小切口开胸进行微创全冠状动脉血运重建的保留胸骨概念（TCRAT）。由于胸部切口和手术时间延长，预计肺部损伤风险会更高。将TCRAT中的肺部并发症与通过全胸骨正中切开术（FS）进行的标准冠状动脉旁路移植术（CABG）进行比较。
分析了151例连续的TCRAT患者（2021年9月至2022年11月）和229例连续的FS患者（2017年1月至2018年12月）的记录，这些患者均接受了择期或急诊CABG。两组患者术前的基线特征（年龄、性别、体重指数、糖尿病、高血压、慢性阻塞性肺疾病、吸烟状况、左心室射血分数、肺动脉高压和欧洲心脏手术风险评估系统II）具有可比性。
在肺部参数方面发现了所检查组之间的差异：术后6小时的霍洛维茨指数（TCRAT为270±72，FS为293±73，P<0.05）、气胸（TCRAT为0%，FS为2.6%，P<0.05）、支气管镜检查（TCRAT为5.9%，FS为1.7%，P<0.05）和胸腔积液（TCRAT为8.6%，FS为3.5%，P<0.05）。此外，两组在平均ICU住院时间（TCRAT为2.4±3.0天，FS为1.8±1.8天，P<0.05）、中风（TCRAT为0%，FS为1.3%，P<0.05）和住院时间（TCRAT为10.9±8.5天，FS为13.2±9.3天，P<0.05）方面也存在差异。在肺不张、再次插管、气管切开术、通气时间和死亡率方面没有差异。
就胸腔积液而言，TCRAT的肺部并发症更为常见，然而，对临床结局没有实质性影响。
