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Clinical and CT-angiographic long-term follow-up of totally endoscopic coronary artery bypass grafting
Objective
Totally endoscopic coronary artery bypass grafting (TECAB) was shown to be feasible and safe, with excellent clinical and angiographic mid-term follow-up. The value of less invasive techniques of coronary revascularization regarding long-term clinical and angiographic outcome is still unknown. Therefore, we aimed to investigate long-term MACCE-rate and LIMA patency-rate in arrested heart TECAB patients.
Methods
From 2001 to 2012 a total of 208 arrested heart TECAB patients were included. 145 (69.7%) were isolated LIMA LAD TECAB’s. Mean age was 58.8 ± 9.4 years, mean logEuroSCORE 1.6 ± 1.5%. The combined clinical endpoint MACCE, defined as a composite of death, myocardial infarction, stroke, re-PCI, re-CABG and any form of target vessel revascularization, was used to evaluate long-term clinical outcome at a mean follow-up of 6.9 ± 2.3 years. Patency rate was assessed using ECG guided cardiac computed tomography. Graft patency was defined as grade A if completely patent, grade B if stenosis was less than 50% and grade 0 if stenosis was more than 50% or for total occlusions. Mean time period from surgery to CT was 6.9 ± 2.8 years.
Results
Survival rate at 1, 5 and 10 years was 100%, 98.3% and 95.8%, respectively. Freedom from MACCE at 1, 5 and 10 years was 93.5%, 85.9% and 83.0%, respectively. At 1, 5 and 10 years freedom from myocardial infarction was 99.0%, 97.4% and 95.9%, freedom from target vessel revascularization 96.0%, 94.3% and 91.7%, percutaneous coronary intervention 94.5%, 91.6% and 84.2%, re-CABG 100%, 99.5% and 99.5%, respectively. Patency rate at 5 and 10 years was 94.9% and 88.1%, respectively. The main reason for long-term graft occlusion was collateral flow. No early graft occlusion due to technical problems was observed.
Conclusions
Arrested heart TECAB shows an excellent long-term clinical follow-up. LIMA patency rate for arrested heart TECAB is comparable to conventional CABG at 10 years after surgery.