Totally Endoscopic Coronary Artery Bypass Grafting: Experience In 1450 Patients
Jade Claessens1, Silke Van Genechten2, Loren Packlé2, Abdullah Kaya1, Alaaddin Yilmaz2.
1Hasselt University, Hasselt, Belgium, 2Jessa Hospital, Hasselt, Belgium.
BACKGROUND: Several minimally invasive procedures have been developed to perform coronary artery bypass grafting (CABG) including endoscopic surgery, either robotically or in an endoscopy setting. In 2016, a study was published of 423 consecutive patients who underwent endoscopic CABG using long-shafted instruments and an endoscope (Endo-CABG). They concluded that Endo-CABG can be considered a safe and effective technique. The aim of this trial is to investigate this technique in a larger series of 1450 patients. METHODS: In this single-center, retrospective study, 1450 patients underwent Endo-CABG from January 2016 until July 2022. Three endoscopic ports (5mm), were positioned in the second, third, and fourth intercostal spaces to harvest the internal mammary arteries. A utility port (3 cm) was used to perform the anastomosis. The primary objectives were major adverse cardiac and cerebrovascular events (MACCE; including cardiac death, non-fatal stroke or myocardial infarction, and reoperation of the replaced valve), 30-day mortality, and all-cause mortality. RESULTS: Patients were followed up for a minimum of 6 months and a maximum of 6,5 years with a mean follow-up index of 0.78 ± 0.37. The overall surgery time was 232.30 ± 67.50 minutes with a cardiopulmonary bypass time of 104.80 ± 48.10 minutes and an aortic clamping time of 59.50 ± 22.22 minutes. A mean of 2.68 ± 0.82 bypasses was used with 632 (47.77 %) in-situ bilateral internal mammary arteries and in 547 (41.35 %) patients a Y-graft was constructed. The Endo-CABG patients were ventilated for 11.20 ± 25.32 hours after the surgery and remained at the intensive care unit for 71.24 ± 84.47 hours. Moreover, the hospital length of stay was 6.60 ± 15.48 days. In-hospital permanent pacemaker implantation was needed in four (0.28%) patients. Furthermore, graft failure during the follow-up occurred in 26 (2.03%) patients. Our primary outcome MACCE occurred in 27 (1.87 %) within 30 days and in 97 (7.40 %) patients within the complete follow-up period. The survival after 30 days was 98.1% while at the end of the follow-up it was 69.8%. CONCLUSIONS: Endoscopic CABG can be considered a safe and feasible technique with good short and mid-term clinical outcomes.
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