Short And Long Term Results After Minimally Invasive Coronary Artery Bypass Grafting Operations
Jan Rychter1, Tomasz Hrapkowicz1, Michał Skrzypek2, Daniel Cieśla3, Mariusz Gąsior4, Marian Zembala1, Michał Oskar Zembala1.
1Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland, 2Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland, 3Department of Science, Training and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland, 43rd Department of Cardiology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
Coronary artery bypass grafting (CABG) despite the rise of percutaneous coronary intervention (PCI), remains the treatment of choice for selected patients with coronary artery disease (CAD). For patients suffering from single-vessel disease of the LAD minimally invasive direct coronary artery bypass (MIDCAB) was developed. Through a small left anterior thoracotomy, the left internal mammary artery (LIMA) can be harvested under direct vision. The evaluation of MIDCAB is Endoscopic Assisted Coronary Artery Bypass (EACAB), where LIMA is harvested using an endoscope. In this study, we review our experience with 387 MIDCAB and EACAB operations. We will present early and long term all-cause mortality, and occurrence of major adverse cardiac and cerebrovascular events (MACCE): angina pectoris (AP), myocardial infarction (MI), stroke, percutaneous coronary interventions (PCI) and reoperation (reCABG).
From 1 January 2008 to 1 January 2016 in our center we performed 51 MIDCAB and 336 EACAB procedures (in summary 387). Mean age was 62,88 ± 10,34 years, mean ejection fraction was 50.0%. Most of patient (46.95%) was in class II according to Canadian Cardiovascular Society grading of angina pectoris. The 25,3% of study population were women. For long-term survival and MACCE free survival, Kaplan-Meier analysis was performed. To assess the role of risk factors for long-term outcome, uni- and multivariant Cox regression analyses were performed.
30-day survival rate was 99,74%. After operation we have lost only one patient. The incidence of MACCE in first 30-day occurred in 10 patients (2,58%). In long term fallow-up survival rate was 93,25% (30 patient died) and incidence of MACCE occurred in 82 patients (21,2%). Age, BMI and poor (21-30%) ejection fraction have a significant influence on survival. Higher age (odds ratio [OR], 1.07; 95% CI, 1.03 - 1.11; P < 0.01) and poor EF (OR, 9.28; 95% CI, 2.05 - 41.98; p<0.01) indicated worse survival. Lower BMI indicated better survival (OR, 0.84; 95% CI, 0.76 - 0.94; p<0.01).
Our study shows that MIDCAB and EACAB operations are safe and efficient procedures for patients with single vessel disease. It is associated with low complication rate, and good long-term results.
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