Long-term Outcomes Of Minimally Invasive Coronary Artery Bypass. Analysis From The Polish Cardiac Surgery Registry
Adrian Stankiewicz, Marek Frank, Robert Trzciński, Tomasz Hirnle.
Cardiac Surgery Department, Bialystok, Poland.
BACKGROUND: Minimally invasive coronary artery bypass (MIDCAB) is designed for the treatment left anterior descending artery stenosis or a part of a hybrid treatment combined with PCI. The aim of the study was to assess the results of MIDCAB procedures based on data obtained from the Polish National Registry of Cardiac Surgery Procedures (KROK). METHODS: Since 2006, KROK has been collecting data about patients who underwent all types of cardiac surgery in Poland. Data transfer to KROK is obligatory. KROK includes preoperative and intraoperative data mortality and complications. Mortality reported in KROK is verified with the data obtained from the National Health Service database. RESULTS: From January 2006 to December 2018, 164,856 patients were operated on due to isolated coronary artery disease (CAD). Among them 2683 (1,6%) MIDCAB procedures were performed. The first reported MIDCAB procedures in KROK database were in 2009 (n = 123, 1,1% of all CABG). Since 2009 has been observed an increasing trend of MIDCAB procedures in Poland (in 2018 n = 451, 4,3%). There were 2041 men (76%), the mean age was 65 ± 9 years. In 1453 pts. (54%) the indication for MIDCAB was one-vessel CAD. 276 pts. (10%) had a 3-vessel disease. 2209 (82%) had no left main stenosis. 606 (22.6%) were operated due to unstable CAD. 2068 pts. (80%) were in 2nd and 3rd CCS class, 2411 (92%) in NYHA 1st and 2nd class. The mean Euroscore II ± SD was 1.56 ± 2.51. Complications occurred in 6.5% of patients (n = 175). The most common complications are bleeding/tamponade 50 (1.9%), respiratory complications 49 (1.8%), wound infection 22 (0.8%), postoperative infarction 23 (0.8%), gastrointestinal complications + multiorgan failure 18 (0.67%), neurological complications 13 (0.48%), renal replacement therapy 11 (0.4%), IABP implantation 8 (0.3%,). 30 days of mortality occurred in 39 patients (1.45%). Total mortality was 7.8% (n = 209). The mean follow up was 3,55 ± 2,57 years. CONCLUSIONS: Based on data obtained from KROK database it can be concluded that the number of MIDCAB procedures is increasing in Poland. MIDCAB is an effective procedure associated with a low number of complications.
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