Long-term results of the endoscopic atraumatic coronary artery bypass
Thomas A Vassiliades1, V Seenu Reddy, John D Puskas
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. thomas.vassiliades@emoryhealthcare.org
Insights
Endoscopic atraumatic coronary artery bypass (endoACAB) demonstrates excellent long-term patency and clinical outcomes for left anterior descending artery grafting. This minimally invasive approach offers a favorable alternative to traditional sternotomy for coronary artery disease treatment.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Retrospective analysis of the endoscopic atraumatic coronary artery bypass (endoACAB) procedure.
- Evaluation of long-term angiographic patency and clinical outcomes.
- Focus on minimally invasive coronary artery bypass grafting.
Purpose of the Study:
- To determine the long-term efficacy of the endoACAB procedure.
- To assess angiographic patency rates of internal mammary artery (IMA) grafts to the left anterior descending (LAD) artery.
- To evaluate clinical outcomes, including event-free survival.
Main Methods:
- 607 patients underwent endoACAB between November 1997 and March 2005.
- Included thoracoscopic IMA harvesting, needle-directed port access, and off-pump, direct-vision anastomoses.
- Mean follow-up of 18.0 months, with angiography performed in 62.4% of patients.
Main Results:
- Left internal mammary artery (LIMA) to LAD grafting achieved 95.2% FitzGibbon A patency.
- Overall LIMA-to-LAD patency (A+B) was 98.5%.
- Five-year event-free survival was 92% +/- 2.4%, with 1.0% 30-day mortality.
Conclusions:
- EndoACAB provides favorable clinical outcomes and angiographic patency compared to traditional sternotomy.
- The procedure is an effective alternative for isolated LAD disease or selected multivessel grafting.
- It can also be utilized in hybrid procedures with percutaneous interventions.
Background:
This retrospective study was undertaken to determine the long-term angiographic patency and clinical outcomes of the endoscopic atraumatic coronary artery bypass (endoACAB) procedure.
Methods:
Between November 1997 and March 2005, 607 consecutive patients underwent an endoACAB consisting of (1) unilateral or bilateral manual, thoracoscopic internal mammary artery (IMA) harvesting, (2) creation of a needle-directed access port in the thoracic soft tissue (non-rib-spreading), (3) cardiac positioning and stabilization using port-based instrumentation, and (4) off-pump, direct-vision, hand-sewn anastomoses to the left anterior descending (LAD), diagonal, obtuse marginal, or main right coronary arteries, or a combination. Mean follow-up time was 18.0 +/- 16.0 months (range, 2.0 to 85.7 months).
Results:
The IMA was used to graft the LAD in all cases. A total of 721 anastomoses were constructed using 636 conduits. Thirty-day mortality was 1.0% (6/607). A total of 379 (62.4%) had coronary angiography after operation at a mean of 18.4 +/- 17.0 months. The overall patency for the LIMA to LAD was FitzGibbon A, 95.2% (324/340), and FitzGibbon A and B, 98.5% (335/340). At 5 years, event-free survival was 92% +/- 2.4%.
Conclusions:
The clinical outcome and angiographic patency of grafting the LAD with the LIMA off pump through a non-rib-spreading incision compares favorably with the reported data of arrested heart grafting through a median sternotomy. The endoACAB offers an excellent alternative for patients with LAD disease as a stand-alone procedure, a multivessel grafting procedure in selected patients, or as part of a hybrid procedure in conjunction with a percutaneous intervention.
