Optimising drain management after endoscopic-assisted minimally invasive coronary surgery

Abstract

Objectives:

This study investigates the outcomes after very early chest drain removal following off-pump endoscopic coronary artery bypass grafting.

Methods:

A single-centre retrospective cohort study was conducted at our hospital. All patients undergoing a primary endoscopic coronary artery bypass grafting procedure between May 2021 and January 2025 were eligible. Both single- or multivessel endoscopic coronary artery bypass grafting procedures were analysed. Patients were excluded if they underwent a redo-operation, coronary unroofing procedure, or conversion to sternotomy.

Results:

A total of 476 patients were included in the final analysis: 246 patients in the conventional drain removal protocol and 230 patients in the early drain removal protocol. Patients in the early drain removal group had significantly higher rates of preexisting comorbidities, preoperative antithrombotic therapy, and urgent procedures (52.6% vs. 36.2%, p < 0.001). The total drain time (5.1 vs. 22.4 h, p < 0.001) and the total drain volume (135 vs. 310 mL, p < 0.001) were both significantly lower in the early postoperative drain removal protocol. There were no significant differences between protocols in the incidence of cardiac tamponade in the first 30 postoperative days (1.3% vs. 0.4%, p = 0.569) and thoracentesis rates (8.7% vs. 5.3%, p = 0.199).

Conclusions:

Very early chest drain removal after endoscopic coronary artery bypass grafting is safe and does not increase postoperative complications for both single- and multivessel revascularisation. This approach enables early ambulation and may contribute to enhanced postoperative recovery.