Review of a 13-Year Single-Center Experience with Minimally Invasive Direct Coronary Artery Bypass as the Primary Surgical Treatment of Coronary Artery Disease

Authors

  • David M. Holzhey
  • Jan P. Cornely
  • Ardawan J. Rastan
  • Piroze Davierwala
  • Friedrich W. Mohr

DOI:

https://doi.org/10.1532/HSF98.20111141

Abstract

Background and Aim of the Study: In this study, we review our experience with 1768 minimally invasive direct coronary artery bypass (MIDCAB) operations. The focus is on long-term outcome with more than 10 years of follow-up.

Methods: All patients undergoing standard MIDCAB between 1996 and 2009 were included. For all 1768 patients, pre-, intra-, and postoperative data could be completed. Long-term follow-up information about health status, major adverse cardiac and cerebrovascular events (MACCE), and freedom from angina was collected annually via questionnaire or personal contact. Five-year follow-up is available for 1313 patients, and 10-year-follow-up is available for 748 patients. A multivariate Cox regression analysis was performed to determine risk factors for long-term outcome.

Results: Mean age was 63.4 ± 10.8 years, mean ejection fraction was 60.0% ± 14.2%, and perioperative mortality risk calculated by logistic EuroSCORE was 3.8 ± 6.2%. In 31 patients (1.75%) intraoperative conversion to sternotomy was necessary. Early postoperative mortality was 0.8% (15 patients); 0.4% (7 patients) had a perioperative stroke. Seven hundred twelve patients received routine postoperative angiogram, showing 95.5% early graft patency. Short-term target vessel reintervention was needed in 59 patients (3.3%) (11 percutaneous transluminal coronary angioplasty (PTCA)/stent, 48 re-operation). Kaplan-Meyer analysis revealed a 5-year survival rate of 88.3% (95% confidence interval [CI], 86.6% to 89.9%) and a 10-year-survival rate of 76.6% (95% CI, 73.5% to 78.7%). The freedom from MACCE and angina after 5 and 10 years was 85.3% (95% CI, 83.5% to 87.1%) and 70.9% (95% CI, 68.1% to 73.7%), respectively.

Conclusions: MIDCAB is a safe operation with low postoperative mortality and morbidity. With excellent short-term and long-term results, it is a very good alternative compared to both percutaneous coronary intervention (PCI) and conventional surgery.

References

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Published

2012-04-26

How to Cite

Holzhey, D. M., Cornely, J. P., Rastan, A. J., Davierwala, P., & Mohr, F. W. (2012). Review of a 13-Year Single-Center Experience with Minimally Invasive Direct Coronary Artery Bypass as the Primary Surgical Treatment of Coronary Artery Disease. The Heart Surgery Forum, 15(2), E61-E68. https://doi.org/10.1532/HSF98.20111141

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