Midterm Follow Up After Minimally Invasive Off Pump Coronary Artery Bypass Surgery As Palliative Revascularization
Magdalena I. Rufa, Adrian Ursulescu, Nora Göbel, Marc Albert, Ulrich FW Franke.
Robert Bosch Hospital, Stuttgart, Germany.
BACKGROUND: In high-risk patients with multivessel coronary artery disease (MV CAD) a guideline indicated complete revascularization bears a high morbidity and mortality risk. Therefore we decided in selected cases for a less invasive approach compared to conventional coronary artery bypass grafting by minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive, multivessel coronary artery bypass grafting (MICS-CABG). This study evaluates the early and midterm follow-up results of these patients operated in our center.
METHODS: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in Heart-Team after carefully assessing each case. Via a left sided anterolateral minithoracotomy, the left internal thoracic artery (LITA) was used to graft the left anterior descending artery ± diagonal artery, while the lateral myocardial territory was grafted with a T-graft from LITA using radial artery, or rarely, saphenous vein segments, both endoscopically harvested. Midterm follow up (mean 38.5 ± 30.6 months) was available for 46 patients (80.7%).
RESULTS: Mean patient age was 79.7 ± 7 years. 46 patients (80.6%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. The mean EuroSCORE II was 16 ± 17.2. 40 patients (70.2%) presented with 3 vessel-disease. 29.8% suffered an acute myocardial infarction within 3 weeks prior to surgery. 50.9% presented an impaired ejection fraction. 4 procedures were urgent and 6 emergent. There were 48 MIDCAB and 9 MICS CABG with no conversions either to sternotomy or to cardio-pulmonary bypass. 8 cases were as hybrid procedures planned and only 15 patients (26.3%) were completely revascularized. During the first 30 days, 4 patients (7.7%) died. A myocardial infarction occurred in only one cases, no patient necessitated immediate reoperation. The 1- 3- and 5-year survival rates were 76%, 56% and 52%.
CONCLUSIONS: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases.<!--EndFragment-->
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