Minimally Invasive CABG is Safe and Reproducible: Report on the First Thousand Cases
Joseph T. McGinn, Jr.1, MASOOD A. SHARIFF1, john P. nabagiez1, Robert Carluchi1, scott SADEL1, RAMAN SHARMA1, Peter abotaga1, Edward Daniele1, Laura Fazio1, Harry Lapierre2, Benjamin Sohmer2, MARC RUEL2.
1STATEN ISLAND UNIVERSITY HOSPITAL, STATEN ISLAND, NY, USA, 2University of Ottawa Heart Institute, Ottawa, ON, Canada.
OBJECTIVE: Minimally invasive CABG (MICS CABG) is a non-robotic, multi-vessel CABG operation performed via a small left thoracotomy. Established in 2005, it has become more commonly performed and better validated, with recent studies demonstrating a safe learning curve and favorable graft patency. We report a combined, two-center experience with the first 1,038 consecutive patients who received this operation.
METHODS: Patients (N=1,038) underwent MICS CABG through a 4-6 cm thoracotomy in the left 4th or 5th intercostal space. The left internal thoracic artery was harvested under direct vision, proximal anastomoses were constructed on the ascending aorta, and all myocardial territories were accessed for distal anastomoses with an epicardial stabilizer and/or apical positioner. Patients were followed with regards to survival and adverse cardiac events, up to a maximum of 8.0 years (mean 2.9±2.0 years).
RESULTS: At operation, mean patient age was 63.9 ± 10.9 years and 255 patients were female (24.6%). Diabetes was prevalent in 328 patients (31.6%), and 470 (45.3%) had some degree of LV dysfunction. A mean of 2.2 ± 0.9 grafts were performed. Peripheral cardiopulmonary bypass assistance was used in 111 patients (10.7%), with no major complication. Perioperative mortality was 9 patients (0.9%). There were 26 (2.6%) conversions to sternotomy, and 30 (2.9%) reoperations for bleeding. New onset atrial fibrillation developed in 215 patients (20.7%). No deep wound infection occurred. At 2.9 years postoperatively, overall survival after MICS CABG was 96.1±0.9%, with 53 patients (5.1%) having undergone percutaneous coronary intervention.
CONCLUSIONS: MICS CABG constitutes an attractive, feasible, and increasingly established minimally invasive alternative in patients who require CABG. Rates of conversion to sternotomy and complications are low, making it a safe, reproducible operation that yields survival and durability results comparable to conventional CABG.
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