Clinical Outcomes After Totally Endoscopic Redo Coronary Artery Bypass Grafting
Loren Packlé1, Alaaddin Yilmaz1, Jade Claessens2, Silke Van Genechten1, Jelena Geens2, Abdullah Kaya1.
1Jessa Hospital, Hasselt, Belgium, 2Hasselt University, Hasselt, Belgium.
BACKGROUND: Sternotomies are primarily performed to conduct redo coronary artery bypass grafting (CABG), even with the well-known possibility of damaging cardiovascular structures. A sternum-sparing alternative for reoperations is totally endoscopic CABG (Endo-CABG), which already showed favorable results for initial surgery. Therefore, the aim is to investigate clinical outcomes after redo Endo-CABG.
METHODS: This monocentric, retrospective trial included 15 patients that underwent redo Endo-CABG from 2016 until 2021. No exclusion criteria were present in this trial. All data were retrospectively collected from the patient’s medical file. Three endoscopic ports (5mm) in the 2nd, 3rd, and 4th intercostal space and a 3cm utility port were used to perform Endo-CABG. The primary outcomes are short- and long-term major adverse cardiac and cerebrovascular events (MACCE) and short- and long-term all-cause mortality.
RESULTS: Cardiopulmonary bypass and aortic clamping times consisted of 97.67 +/- 51.58 and 46.15 +/- 43.19 minutes, respectively. Patients were ventilated for a median of 20 [23.50] hours. Additionally, perioperative blood loss consisted of 944.70 +/- 706.26 ml, while postoperative blood loss for 24 hours was 1094 +/- 843.80 ml. A median of 1 [1] bypass was grafted during redo Endo-CABG and a Y-construction was made in four patients (26.67%). Moreover, patients remained at the intensive care unit and hospital for a median of 73 [41.25] hours and 7 [2.75] days, respectively.
30-day and one-year MACCE were 0%. Long-term MACCE consisted of 6.67% as one patient suffered a myocardial infarction 466 days after surgery (Figure 1). In addition, two patients (13.33%) passed away because of multiorgan failure and respiratory failure within 30 days after surgery. One-year and long-term mortality did not differ from 30-day mortality since no additional patients died (Figure 1). Furthermore, three patients required percutaneous coronary intervention during follow-up, although not for their target lesion.
CONCLUSIONS: Redo Endo-CABG is a feasible alternative to perform re-operative CABG without sternal re-entry. Short- and long-term mortality and MACCE are acceptable. To further enhance the outcomes, future research should concentrate on prospective trials. 
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