***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Pulmonary dysfunction is still a major problem in coronary artery bypass grafting ( CABG ) . The purpose of this r and omized study was to determine the effect of different CABG techniques on pulmonary function . METHODS Fifty eight patients with severe obstructive pulmonary disease had elective isolated coronary surgery .  The surgical methods for the patients with chronic obstructive pulmonary disease ( COPD ) were st and ard CABG in 18 patients ( group 1 ) , beating heart surgery in 19 patients ( group 2 ) , and minimally invasive direct coronary artery bypass grafting ( MIDCABG ) in 21 patients ( group 3 ) . RESULTS The earliest extubation time was from group 3 ( p < 0.001 ) . The average stay in the intensive care unit was significantly longer in group 1 ( 2.6 + /- 1.5 days ) than in groups 2 ( 1.4 + /- 0.8 days ) and 3 ( 1.1 + /- 0.8 days ) ( p < 0.05 ) . The most prevalent respiratory morbidity was atelectasis that developed in 6 patients from group 1 , in 2 patients from group 2 , and in 3 patients from group 3 . Forced expiratory volumes in 1 second ( FEV1 ) obtained in the second postoperative month were significantly lower than preoperative values only in group 1 ( p < 0.05 ) . Forced vital capacity ( FVC ) values were significantly lower than the preoperative values in all three groups ( p < 0.05 ) . CONCLUSIONS Off-pump bypass surgical procedures are more advantageous than on-pump methods for patients with COPD . These patients can be operated on using the beating heart technique or by using MIDCABG to prevent side effects of CPB on pulmonary function and effects of sternotomy OBJECTIVE The authors performed a retrospective cost analysis for patients undergoing revascularization of their left anterior descending ( LAD ) coronary artery either by st and ard coronary artery bypass grafting ( CABG ) , percutaneous transluminal coronary angioplasty ( PTCA ) , or minimally invasive coronary artery bypass grafting ( MICABG ) .  SUMMARY BACKGROUND DATA Minimally invasive CABG has become a safe and effective alternative treatment for single-vessel coronary artery disease . However , the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost . METHODS The authors conducted a retrospective analysis of three patient groups undergoing LAD coronary revascularization from January 1995 to July 1996 . Ten patients were selected r and omly from this period after PTCA of an LAD lesion with or without stenting . Nine patients underwent st and ard CABG on cardiopulmonary bypass with a left internal mammary artery . Nine patients received MICABG  via a limited left anterior thoracotomy and left internal mammary artery to LAD grafting without the use of cardiopulmonary bypass . RESULTS Percutaneous transluminal coronary angioplasty ( n = 10 ) was unsuccessful in two patients . One patient in the MICABG group ( n = 9 ) was converted successfully to conventional CABG because of an intramyocardial LAD and dilated left ventricle . There was no operative morbidity or mortality in any group . Average length of stay postprocedure was decreased significantly for both the MICABG and PTCA groups when compared with that of conventional CABG ( n = 9 ) ( 2.7 + 0.26 , p = 0.009 , and 2.6 + 0.54 , p = 0.006 , vs. 4.8 + 0.46 , respectively ) . Total hospital costs for the MICABG and PTCA groups were significantly less when compared with those of st and ard CABG ( $ 10,129 + 1104 , p = 0.0028 , and $ 9113 + 3,039 , p = 0.0001 , vs. $ 17,816 + 1043 , respectively ) . There were no statistically significant differences between the MICABG and PTCA groups . CONCLUSIONS The final role of minimally invasive CABG is unclear . This procedure is clearly cost effective when compared with that of PTCA and conventional CABG . The long-term patency rates for MICABG will determine its overall efficacy OBJECTIVE In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass ( CPB ) in conventional and minimally invasive coronary artery bypass grafting , inflammatory response was studied in a prospect i ve r and omized trial in patients referred to single-vessel coronary artery bypass grafting . METHODS Four surgical techniques were compared : group 1 , median sternotomy with CPB in ten patients ( eight male , two female ; aged 59.6+/-11.0 years ( mean+/-SD ) ) ; group 2 , median sternotomy and off-pump in ten patients ( seven male , three female ; aged 65.1+/-10.0 years ) ; group 3 , minithoracotomy with CPB in ten patients ( seven male , three female , aged 61.2+/-10.4 years ) ; group 4 , minithoracotomy and off-pump in ten patients ( nine male , one female , aged 62.9+/-9.8 years ) . All patients received a left internal mammary artery graft to the left anterior descending artery ( LAD ) . Clinical data , perioperative values of cytokines and cardiac enzymes were monitored . RESULTS There were no major complications . Troponin-T and creatine kinase isoenzyme MB ( CK-MB ) levels were significantly higher in CPB procedures ( P<0.0056 ; multivariate general linear model ) . Interleukin-6 ( IL-6 ) levels were significantly higher in minithoracotomy procedures . Interleukin-1 ( IL-1 ) was significantly increased in all patients compared with the preoperative values . CONCLUSIONS The use of CPB is combined with higher levels of troponin-T and CK-MB as signs of myocardial damage . Surgical access was identified as a trigger of inflammatory response , as minithoracotomy is related to higher levels of IL-6 . IL-1 increased in all procedures and this occurred independently of the surgical access or the use of CPB , which points out a potential relationship between inflammatory response and anesthesia . Neither CPB nor surgical access influenced the clinical outcome in the treatment of coronary artery single-vessel bypass grafting BACKGROUND This study compares conventional coronary artery bypass grafting ( CABG ) with port access CABG via a left anterior small thoracotomy in patients requiring surgical multivessel revascularization .  Clinical , neuropsychological , and angiographic outcomes were studied , as well as parameters of myocardial and cerebral protection . Pathogenicity of cardiopulmonary bypass ( CPB ) was further evaluated by measuring parameters of peripheral limb ischemia and inflammatory whole-body response . METHODS In a prospect i ve r and omized study , 40 patients who required multivessel CABG were assigned to either conventional CABG via complete median sternotomy ( group A ) or port access CABG via minithoracotomy ( group B ) . Control angiograms were performed in group B only . In addition , patients underwent  neuropsychological testing after the operation . CK , CK-MB , and Troponin T levels were documented . S-100B protein and neuron-specific enolase ( NSE ) served to quantify cerebral injury . The terminal complement complex ( C5b-9 ) and myeloperoxidase concentrations were determined to analyze inflammatory whole-body response after CPB . RESULTS There was no mortality . One patient suffered a retro grade aortic dissection immediately after onset of CPB , but had an uneventful postoperative course after surgical repair . Troponin T and CK-MB showed no difference between groups . CK and myoglobin were significantly higher in the minimally invasive cohort . Changes in complement activation ( C5b-9 ) and myeloperoxidase during CPB markers of the whole-body inflammatory response were similar in both groups . S-100B concentrations in the port access group were significantly higher , whereas NSE levels were similar in both groups . Both groups did not display any significant difference in neuropsychological testing . CONCLUSIONS Minimally invasive multivessel CABG via minithoracotomy using port access technology is feasible and safe . Though prolonged operating and CPB times with significantly higher S-100B concentrations were observed in group B , equivalent myocardial and cerebral protection and similar whole-body inflammatory response were documented OBJECTIVE Minimally invasive coronary artery bypass grafting is safe and widely applicable , and may be associated with fewer transfusions and infections , and better recovery than st and ard coronary artery bypass grafting . However , graft patency rates remain unknown . The Minimally Invasive Coronary Artery Bypass Grafting Patency Study prospect ively evaluated angiographic graft patency 6 months after minimally invasive coronary artery bypass grafting . METHODS In this dual-center study , 91 patients were prospect ively enrolled to undergo minimally invasive coronary artery bypass grafting via a 4- to 7-cm left thoracotomy approach .  The left internal thoracic artery , the ascending aorta for proximal anastomoses , and all coronary targets were directly accessed without endoscopic or robotic assistance . The study primary outcome was graft patency at 6 months , using 64-slice computed tomography angiography . Secondary outcomes included conversions to sternotomy and major adverse cardiovascular events ( Clinical Trial Registration Unique identifier : NCT01334866 ) . RESULTS The mean age of patients was 64 ± 8 years , the mean ejection fraction was 51 % ± 11 % , and there were 10 female patients ( 11 % ) in the study . Surgeries were performed entirely off-pump in 68 patients ( 76 % ) . Complete revascularization was achieved in all patients , and the median number of grafts was 3 . There was no perioperative mortality , no conversion to sternotomy , and 2 reopenings for bleeding . Transfusion occurred in 24 patients ( 26 % ) . The median length of hospital stay was 4 days , and all patients were followed to 6 months , with no mortality or major adverse cardiovascular events . Six-month computed tomography angiographic graft patency was 92 % for all grafts and 100 % for left internal thoracic artery grafts . CONCLUSIONS Minimally invasive coronary artery bypass grafting is safe , feasible , and associated with excellent outcomes and graft patency at 6 months post-surgery OBJECTIVE The results of mitral repair for complex Barlow valves are adequate and support earlier intervention . It is unknown whether these results are reproducible in the context of minimally invasive surgery via right minithoracotomy . METHODS We r and omized patients with Barlow mitral disease ( bileaflet prolapse ) to have conventional open repair via median sternotomy ( MS group ) or minimally invasive ( MI group ) repair .  Repair was done using polytetrafluoroethylene chordal reimplantation for both leaflets . In the  MI group , we adopted right minithoracotomy , peripheral cannulation , external aortic clamping , and surgery under direct vision . RESULTS Both groups comprised 70 patients . The operative and the cardiopulmonary bypass times were significantly longer in the MI group ( P = .003 and P = .012 ) . Mitral repair was successful in 98.5 % MI patients and 100 % MS patients . Operative mortality was comparable . The mean mechanical ventilation time , intensive care unit stay , and hospital stay were lower in the MI group ( P = .014 , P = .02 , and P = .03 , ) . Mean pain score was lower in the MI group at postoperative days 2 and 4 . At follow-up , the freedom from moderate ( 2 + ) or severe ( 3 + or 4 + ) mitral regurgitation was 98 % versus 97 % ( P = .9 ) . Two patients underwent reoperation ( 1 in each group ) for late failure of repair . The Kaplan-Meier analysis confirmed these results . CONCLUSIONS Our data indicate that the optimal st and ard-of-care results of mitral repair for complex disease ( Barlow ) are reproducible in the minimally invasive setting s through right minithoracotomy and direct vision . The minimally invasive technique can be proposed for complex mitral disease and early referral of these patients can be encouraged BACKGROUND AND AIM OF THE STUDY A prospect i ve r and omized study was performed to compare conventional with minimally invasive aortic valve replacement ( AVR ) . METHODS Forty consecutive patients scheduled for elective aortic valve surgery were prospect ively r and omized either to the conventional group ( group A , complete median sternotomy ) or minimally invasive group ( group B , partial upper sternotomy ) . Intraoperative and postoperative clinical data , and markers of myocardial and cerebral protection were determined . Neuropsychological tests were carried out to quantify psychological disorders . RESULTS Operative time and cardiopulmonary bypass time were slightly longer in group B , but not significantly so . No significant inter-group differences were found for postoperative pain scores and respiratory function . Chest tube drainage was significantly less in group B ( 495 + /- 165 versus 240 + /- 69 ml , p = 0 
    Output:
    
Minimally invasive cardiac surgery is as safe as conventional surgery and could reduce costs due to a shorter period spent in ICU