Long-term Outcome Of Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery: A Single Center Experience
SHAKIL FARID, Jason Ali, Victoria Stohlner, Ruhina Alam, Peter Schofield, Samer Nashef, Ravi De Silva.
PAPWORTH HOSPITAL, CAMBRIDGE, United Kingdom.
The primary objective was to investigate the long term survival of patients who underwent single vessel coronary revascularization with minimally invasive direct coronary artery bypass (MIDCAB) surgery. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), and the incidence of myocardial infarction.
This is a retrospective study of prospectively collected data of patients who underwent MIDCAB procedure in a single centre between January 2001 and December 2015. Procedures were performed either through small left anterolateral thoracotomy or lower midline sternotomy.
A total of 182 patients were identified- 100 underwent MIDCAB to the left anterior descending artery and 82 underwent hybrid revascularisation (Coronary stents to coronary arteries other than the left anterior descending artery along with MIDCAB to the left anterior descending artery). The mean age was 62 (±10.1) years and majority of them were male (82%). Preoperatively 72.5% patients had good left ventricular function.The median follow-up period was 10.9 years.There was no in-hospital or 30 day mortality. The 10 year actuarial survival was 84.8%. Freedom from repeat revasculrisation was 98.9% at 1 year, 89.9% at 10 years. At follow-up freedom from myocardial infarction was 96.7% while freedom from angina was 92.9%.
Within the limitations imposed by retrospective analyses, our study demonstrates an excellent long-term outcome in patients undergoing MIDCAB with or without hybrid revascularization. For isolated left anterior descending artery disease MIDCAB should be considered while hybrid revascularization (PCI and MIDCAB) should be considered for multi-vessel disease, particularly in patients with a low SYNTAX score (<23).
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