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Minimally Invasive Coronary Bypass Angiographic Patency Study: Safety Results and Outcomes to 1 Year
Joseph T. McGinn1, Harry Lapierre2, Masood Shariff1, Benjamin Sohmer2, Nikhil Goyal1, Marc Ruel2.
1Staten Island University Hospital, Staten Island, NY, USA, 2University of Ottawa Heart Institute, Ottawa, ON, Canada.

OBJECTIVE: The Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) Patency Study prospectively evaluated angiographic bypass graft patency 6 months after MICS CABG. The study also assessed complications and outcomes during the first postoperative year.
METHODS: The MICS CABG Patency Study was carried out at 2 centers and enrolled a total of 90 patients scheduled to undergo MICS CABG. Through a 4-7cm left thoracotomy, the left internal thoracic artery (LITA), the ascending aorta for proximal anastomoses, and all distal coronary targets were accessed without endoscopic or robotic assistance. The study's primary outcome was graft patency at 6 months, using 64-slice CT angiography. Feasibility and safety outcomes including conversions to sternotomy and major adverse cardiovascular events (MACE) were prospectively recorded. (Clinical Trial Registration Unique identifier: NCT01334866)
RESULTS: Mean age was 64±8 years, and 80 patients (89%) were male. Twenty-seven patients (30%) had diabetes, 28 (31%) had a previous myocardial infarction, and mean ejection fraction was 51±11%. MICS CABG was completed in all patients without conversion to sternotomy, and using semi-elective pump assistance in 24 (27%). Complete revascularization was achieved in all patients, and the median number of grafts was 3 (mean 2.4±0.9). No perioperative mortality or stroke occurred. Transfusion was required in 17 patients (19%), and 2 (2%) were reopened for bleeding. Postoperative atrial fibrillation occurred in 9 patients (10%), and pleural effusions in 13 (14%). Two patients (2%) developed a superficial wound infection. The median length of hospital stay was 4 days, and follow-up to 1 year revealed no mortality or MACE. At 6 months, the overall CT angiographic graft patency was >93% for all grafts, and 100% for LITA grafts.
CONCLUSIONS: MICS CABG is feasible, safe, and reveals excellent outcomes in the first year after surgery. Follow-up will continue in order to ascertain the procedure's durability.


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