10 year follow-up of patients undergoing totally endoscopic coronary artery bypass grafting
Markus Kofler1, Sebastian Reinstadler2, Lukas Stastny3, Alim Basaran3, Thomas Schachner3, Guy Friedrich2, Dominik Wiedemann4, Johannes Bonatti5, Nikolaos Bonaros6.
1Medical University of Innsbruck, Innsbruck, Austria, 2Medical University of Innsbruck, Cardiology, Austria, 3Medical University of Innsbruck, Cardiac surgery, Austria, 4Medical University of Vienna, Cardiac surgery, Austria, 5Cleveland Clinic Abu Dhabi, Cardiac Surgery, United Arab Emirates, 6Medical University of Innsbruck, Cardiac Sugery, Austria.
OBJECTIVE: Totally endoscopic coronary artery bypass grafting (TECAB) is an emerging and apparently a safe and feasible minimally invasive treatment option for surgical coronary artery disease in selected patients. Long-term results are still missing. Therefore, we aimed to investigate the clinical long- term outcome.
METHODS: We analyzed 197 consecutive isolated TECAB- patients at a median follow-up period of 78 [61-114] months, operated at a single center from 2001 to 2011. Median age was 59.0 [53-67] years, 143 (72.6%) were male patients. Arrested heart TECAB was performed in 93%, 7% were beating heart TECAB. Single vessel TECAB was performed in 82%, double vessel TECAB in 18%. Clinical follow-up included death, stroke, myocardial infarction, re-CABG re-PCI, target vessel revascularization (TVR) and recurrence of angina as endpoints. The combined endpoint of major adverse cardiac and cerebral events (MACCE) was defined as a composite of death, stroke, myocardial infarction and any form of repeat target vessel revascularization (TVR).
RESULTS: We observed no perioperative death and a stroke rate of 1.5%. After a median follow-up of 78 [61-114] months we report a survival rate of 96.4% (190/197), a freedom from myocardial infarction of 92.9% (183/197), freedom from stroke of 93.9% (185/197), freedom from re-CABG and re- PCI of 98.5% (195/197) and 87.3% (172/197) respectively and freedom from TVR of 94.4% (186/197). Out of the patients undergoing TVR, only three had a graft occlusion during the first year after operation. Long- term freedom from MACCE was 77.7% (153/197).
CONCLUSIONS: This is the first study providing results regarding clinical outcome of TECAB- patients after such a long follow-up period. Despite the fact that patients are highly selected with limited coronary artery disease the long- term results reveal TEECAB as excellent treatment option for these patients.
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