Minimally Invasive Coronary Revascularization For Single And Multivessel Disease: 15 Years Experience And Follow-up
Alberto Repossini1, Lorenzo Di Bacco1, Fabrizio Rosati1, Laura Giroletti1, Maurizio Tespili2, Antonio Saino2, Davide Personeni2, Claudio Muneretto1, Gianluigi Bisleri3.
1Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy, 2Division of Cardiology, Ospedale Bolognini, Seriate, Bergamo, Italy, 3Division of Cardiac Surgery, Queen's University, Kingston, ON, Canada.
OBJECTIVE: Minimally Invasive Direct Coronary Artery By-pass (MIDCAB), meaning Left Internal Mammary Artery on Left Anterior Descending (LIMA-LAD)graft, is a safe and less traumatic approach, with comparable results with conventional surgery in terms of outcome and long-term patency of the graft. Aim of this study is to retrospectively evaluate long-term outcome of a large series of patients operated with this technique.
METHODS: From January 1997 to December 2005, 660 consecutive patients underwent MIDCAB(off-pump minithoracotomy): 404 patients(61.2%)with isolated proximal-LAD-disease(MIDCAB), 136 patients(20.6%)with multi-vessel (MVD)disease as a part of Hybrid Coronary Revascularization(HCR) and 120 patients with MVD(18.2%) in association with optimal medical therapy (MIDCAB+OMT). Follow-up visits(97.6% complete) were performed at 6 and 12months postoperatively and afterwards on a yearly basis by outpatient visits and phone interview with collection of clinical data.
RESULTS: Perioperative risk of mortality assessed by logistic EuroSCORE I was 7.8%±5.4%, mean age was 76±14.6years, mean ejection fraction was 55.2%±18.2% and early post-operative death was 0.8%(5 patients). Mean follow up was 9.3±3.2years. At 10 years no surgical re-intervention has been performed for LIMA-LADgraft failure. Mean SYNTAX score in HCR group was 27.5±3.5 and 11.3±3.5 of non-LAD lesions. Overall survival at 5 and 10years was respectively 82.6%(95% confidence interval [CI]: 79.1%-86.1%) and 70.6%(95% CI: 67.5%-73.7%). At 5 and 10 years freedom from cardiac death was respectively 88.4%(95% confidence interval [CI]: 84.7%-92.1%) and 75.5%(95% CI: 69.9%-81.1%) and freedom from major adverse cardiac and cardiovascular events was 84.2%(95% CI: 79.1%-89.7%) and 71.7%(95% CI: 68.1%-75.3%). HCR and MIDCAB+OMT were compared for MACCE with log-rank test with no difference(p=0.34), however incidence of repeated revascularization on non-LAD vessels was significantly higher in HCR(p=0.02).
CONCLUSIONS: MIDCAB is a safe revascularization option with excellent short and long-term results. MIDCAB should be considered as a valuable strategy both for LAD complex lesions alone and also in MVDpatients, with lower invasiveness than conventional surgery. Moreover in HCRgroup, patients with LAD complex coronary lesions should take advantage of LIMA-LAD revascularization, ensuring long term duration in term of graft patency, reducing SYNTAX score when due to LAD lesions, lowering target vessel revascularization rates and cardiac adverse events when compared to percutaneous coronary intervention.
Back to 2017 Cardiac Track Overview