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

All articles of this category Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) has gained wide acceptance as treatment option for revascularization of the left anterior descending artery (LAD) in patients discussed within the heart team. Here we present our single-center experience with 220 consecutive patients. Methods: All patients undergoing MIDCAB through a left anterior mini-thoracotomy between January 1st 2009 and December 31st 2015 were included (47 were hybrid procedures with combined MIDCAB and PCI). Preoperative, intraoperative, postoperative and follow-up information about major adverse cardiac and cerebrovascular events (MACCE) and need for re-intervention were collected. Results: Mean age was 65 ±12years, median EuroScore 3 (0–14), 81% were male patients. All patients except for one were successfully operated without cardiopulmonary bypass. Eight patients with unexpected severely calcified LADs were electively converted to sternotomy (3.6%), two further ones emergently due to hemodynamic instability. 104 patients (47%) were extubated in the theater and 95 (43%) on the day of surgery. 30 patients (14%) were transferred directly to intermediate care and hospital stay was 7(1–49) days. 30-day mortality was 1.4% and there was no stroke. Re-exploration for bleeding was necessary in five patients (2.3%) and was achieved through the initial access without conversion. 207 patients (94%) did not need red blood cell transfusion. Mean follow up was 26 months and was completed in 214 patients (97%) with 92 ± 0.2% and 89 ± 0.3% survival and 97 ± 1.4% and 94 ± 0.3% freedom of MACCE at three and five years respectively. Three patients (1.4%) had a re-intervention of the LAD due to bypass closure (1 day, 10 days and 4 months postoperatively). Conclusion: Our results show that MIDCAB is a safe procedure in specialized centers with fast recovery, low postoperative morbidity, mortality and favorable mid-term MACCE-free survival and freedom from re-intervention comparable to CABG through sternotomy. However, the indication should be discussed within the Heart Team to choose the most adequate therapy for each individual patient (CABG vs. PCI vs. MIDCAB vs. hybrid MIDCAB and PCI).