alexa Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients.


Journal of Clinical & Experimental Cardiology

Author(s): Holzhey DM, Jacobs S, Mochalski M, Walther T, Thiele H,

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Abstract BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending artery has become a routine operation. Here we present the experience after more than 1300 MIDCAB procedures with up to 7 years of follow-up. METHODS: All patients undergoing standard MIDCAB between 1996 and 2004 were included. Long-term follow-up information about health status, major cardiac and cerebral adverse events, and freedom of angina was collected annually by a questionnaire or personal contact. Preoperative, intraoperative, and postoperative data could be completed for all 1347 patients. Five-year follow-up was available for 450 patients and 7-year follow-up for 194 patients. RESULTS: Mean age was 63.2 years (range, 25 to 92 years) and mean ejection fraction was 0.61 +/- 0.14. In 23 patients (1.7\%), intraoperative conversion to sternotomy or CPB, or both, was necessary. Early postoperative mortality was 0.8\% (n = 11), and 0.4\% (n = 5) had a perioperative stroke. A routine postoperative angiogram in 709 patients showed 95.6\% early graft patency. Short-term target vessel reintervention was needed 55 patients (4.1\%): 10 had percutaneous transluminal coronary angioplasty/stent and 45 had reoperation. A repeat angiogram at the 6-month follow-up was available in 350 patients and demonstrated 94.3\% graft patency. Kaplan-Meier analysis revealed a 5-year survival of 91.9\% (95\% confidence interval [CI], 90.1\% to 93.8\%) and a 7-year survival of 89.4\% (95\% CI, 86.7\% to 92.1\%). The freedom of major adverse events and angina was 89.5\% (95\% CI, 87.4\% to 91.5\%) after 5 years and 83.3\% (95\% CI, 79.0\% to 87.5\%) after 7 years. CONCLUSIONS: MIDCAB can be safely performed with low postoperative mortality and morbidity. The excellent short-term and long-term survival as well as freedom from major adverse cardiac and cerebral events and angina compare favorably with stenting and conventional surgery. This article was published in Ann Thorac Surg and referenced in Journal of Clinical & Experimental Cardiology

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