Key result
MICS with ERAS protocols matches or beats full sternotomy outcomes while speeding recovery and reducing trauma.
Why the study?
Numerous recent trials have examined minimally invasive approaches in cardiac surgery, and ERAS protocols have recently been applied to MICS patients.
Does minimally invasive cardiac surgery (MICS) with or without ERAS improve outcomes and reduce length of stay compared to full sternotomy in cardiac surgery patients?
Does minimally invasive cardiac surgery (MICS) with or without ERAS improve outcomes and reduce length of stay compared to full sternotomy in cardiac surgery patients?
Minimally invasive cardiac surgery, especially when combined with ERAS protocols, provides equivalent or better outcomes with faster recovery and less surgical trauma compared to full sternotomy.
May support MICS with ERAS for faster recovery in selected patients; leaves open confirmation by randomized trials before practice change.
PURPOSE OF REVIEW: Numerous recent trials have examined the potential benefits of treating cardiac surgery patients with a minimally invasive approach. Recently, Enhanced Recovery After Surgery (ERAS) has also been applied to cardiac surgery, and specifically to minimally invasive cardiac surgery (MICS) patients. This review will explore current evidence regarding MICS, as well as the combination of MICS plus ERAS. RECENT FINDINGS: Multiple contemporary prospective and retrospective trials have published data demonstrating equivalent or better outcomes with reduced length of stay (LOS) for MICS patients compared to patients undergoing full sternotomy. In fact, recent reviews and met-analyses suggest that MICS is associated with reduced atrial fibrillation, wound complications, blood transfusion, LOS, and potentially cost. Additionally, several new trials reporting longer term follow-up on MICS coronary and valve surgery have demonstrated durable results. Emerging literature on the benefits of combining MICS and ERAS perioperative protocols have also reported promising results regarding reduced LOS and faster recovery. SUMMARY: Minimally invasive cardiac surgery appears to provide patients with equivalent or better outcomes, faster recovery, and less surgical trauma compared to full sternotomy. The addition of ERAS phase specific perioperative protocols can help maximize the benefits of MICS.
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Salenger et al. (2023) conducted a review in Cardiac surgery. Minimally invasive cardiac surgery (MICS) and Enhanced Recovery After Surgery (ERAS) vs. Full sternotomy was evaluated. Minimally invasive cardiac surgery, especially when combined with ERAS protocols, provides equivalent or better outcomes, faster recovery, and less surgical trauma compared to full sternotomy.
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