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Thorac Cardiovasc Surg 2015; 63(04): 313-318
DOI: 10.1055/s-0034-1389085
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Mid-Term Outcomes of Minimally Invasive Direct Coronary Artery Bypass Grafting

Diana Reser
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
,
Mathias van Hemelrijck
2   University of Zurich, Zurich, Switzerland
,
Jovana Pavicevic
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
,
Herman Tolboom
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
,
Tomas Holubec
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
,
Volkmar Falk
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
,
Stephan Jacobs
1   Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

30 April 2014

02 July 2014

Publication Date:
10 September 2014 (online)

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Abstract

Background Minimally invasive direct coronary artery bypass grafting (MIDCAB) has gained wide acceptance for the treatment of single vessel disease of the left anterior descending artery (LAD). Here, we present our single center experience of 152 consecutive patients.

Materials and Methods All patients underwent MIDCAB through a left anterior minithoracotomy between January 1, 2009, and December 31, 2012. Preoperative, intraoperative, postoperative, and follow-up data including major adverse cardiac and cerebrovascular events (MACCE) and need for re-intervention were collected.

Results Mean age was 64.4 ± 11 years, median additive EuroSCORE 3 (0–11), 84% were male. All except one patient were successfully operated without cardiopulmonary bypass. Seven patients with unexpected severely calcified LADs were converted to sternotomy (4.6%); 91.3% were extubated in the operating room or on the day of surgery. Median stay at the intensive care unit and in hospital were 1 (0–97) and 7 (1–49) days, respectively. Thirty-day mortality was 1.9%. There was no stroke. Five patients (3.2%) had to be re-explored for bleeding and 95% received no transfusion. Median follow-up was 24 months (0–97) and complete in 93.3% with overall survival of 92.4 ± 0.2% and MACCE-free survival of 96.1 ± 1.7%. Two patients had a re-intervention of the LAD.

Conclusion MIDCAB is a safe procedure with low postoperative morbidity, mortality, and favorable mid-term MACCE-free survival in selected patients that should be discussed in a heart team setting to evaluate the “ideal” individual treatment option.

Keywords

coronary artery bypass grafts surgery - CABG - cardiac - off-pump surgery
 

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