Fast‐Track Extubation in the Operating Room After Minimally Invasive Direct Coronary Artery Bypass Grafting

Introduction: Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers a less traumatic alternative to conventional median sternotomy. The benefits of avoiding sternotomy align with the goals of enhanced recovery after surgery (ERAS). While early extubation benefits have been demonstrated in conventional CABG, evidence on extubation in the operating room remains scarce. We present a single‐center experience with immediate extubation outside of a structured ERAS concept. Methods: Patients undergoing MIDCAB via a left anterolateral thoracotomy with unilateral ventilation between August 2022 and March 2024 were retrospectively analyzed. Patients who were extubated in the operating room (extubation in tabula, EIT) were compared to those who were extubated in the intensive care unit (ICU) (control, CTRL). The primary outcome was a transfer to general ward within 24 h after admission to ICU. Secondary outcomes aimed to assess safety endpoints, including the rate of reintubation, major adverse cardiac and cerebrovascular events, and length of stays. Results: A total of n = 79 patients were included. After propensity score matching, the cohorts consisted of n = 20 (CTRL) and n = 35 (EIT) patients, who had a median age of 68 years (IQR: 63–75), were 83.6% male, and showed comparable baseline characteristics. The majority of patients (92.7%) underwent single arterial bypass grafting. Fifteen patients (27.3%) met the primary endpoint with no significant difference between the two cohorts (CTRL 20.0%, EIT 31.4%, p = 0.531). Three patients in the EIT cohort required reintubation due to revision surgery ( n = 2) and cardiopulmonary resuscitation ( n = 1) due to thrombotic ischemia. The median stay in ICU was 23 h (IQR: 18–28), the total length of hospital stay 6d (IQR: 5–8) respectively. Conclusion: EIT after MIDCAB is safe and feasible. However, on its own, it does not affect subsequent transfers and should therefore be only considered as the first step toward a comprehensive ERAS approach.