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

Abstract

Background: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has the advantage of allowing
\narterial grafting on the left anterior descending artery without a sternotomy incision. We present our
\nsingle-center clinical experience of 66 consecutive patients. Methods: All patients underwent MIDCAB through
\na left anterior small thoracotomy between August 2007 and July 2015. Preoperative, intraoperative, postoperative
\nand follow-up data—including major adverse cardiovascular and cerebrovascular events (MACCE),
\ngraft patency, and the need for re-intervention—were collected. Results: The mean age of the patients was
\n69.4±11.1 years and 73% were male. There was no conversion to an on-pump procedure or a sternotomy
\nincision. The 30-day mortality rate was 1.5%. There were no cases of stroke, although 2 patients had to be
\nre-explored for bleeding, and 81.8% were extubated in the operating room or on the day of surgery. The
\nmedian stay in t he i ntensive c are u nit and in t he h ospital were 1 .5 a nd 9.6 days, respectively. The median
\nfollow-up period was 11 months, with a 5-year overall survival rate of 85.3%±0.09% and a 5-year MACCE-free
\nsurvival rate of 72.8%±0.1%. Of the 66 patients, 32 patients with 36 grafts underwent a postoperative graft
\npatency study with computed tomography angiography or coronary angiography, and 88.9% of the grafts
\nwere patent at 9.7±10.8 months postoperatively. Conclusion: MIDCAB is a safe procedure with low postoperative
\nmorbidity and mortality and favorable mid-term MACCE-free survival.