OC76 THE MORE PROCEDURE (MININVASIVE, OPCAB, RAPID SURGICAL INTENSIVE CARE UNIT EXIT, EXTUBATION INTO THE OPERATING ROOM): OUR MININVASIVE APPROACH TO SURGICAL MYOCARDIAL REVASCULARIZATION

Abstract

Abstract Background and Aim: To compete with PCI invasiveness, we adopted a composite surgical strategy which we called the MORE approach. Methods: Criteria for enrolment into the MORE study were haemodynamic stability and EF ≥ 45%. Criteria for operating room (OR) extubation were: normothermia, good cardiac output and no evidence of bleeding. From November 2016 to April 2018, 85 ACS patients underwent MORE technique: lower partial or a full sternotomy through a 10 cm skin Minincision; complete Off-pump revascularization; Rapid mobilization; Extubation into the OR. Results: Five patients failed OR extubation and 10 patients needed incision extension for poor coronary vessel exposure. We did not register any operative mortality, perioperative MI or CV events. Mean graft/patient ratio was 2.8. Early mobilization allowed 78 (92%) patients to be seated edge-of-bed after two hours. In the afternoon, 65 patients returned to the Coronary Intensive Care Unit. This rapid surgical intensive care unit (SICU) exit allowed 31 afternoon patients to be accommodated in the SICU bed, freed up by the morning cases. This offered economic benefits: taking up less ‘valuable bed space’ in the first operative day and increasing the number of the surgical procedures as a result of an improved SICU bed availability. Conclusions: MORE protocol allowed selected ACS OPCAB patients to be OR extubated, early mobilised and same-day discharged from the SICU. The minincision, avoiding excessive rib traction, reduced the postoperative pain and was a very well-accepted cosmetic bonus. The rapid SICU bed turnover allowed an overutilization of our present logistic facilities.