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Determinants of late outcome after minimally invasive direct coronary artery bypass
G Pompilio1, F Alamanni, P M Tartara
1Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy. giulio.pompilio@ccfm.it
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers good long-term survival, but female patients face higher risks for repeat revascularization. Careful patient selection is crucial for successful MIDCAB outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Coronary Artery Bypass Grafting
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is established for left anterior descending (LAD) revascularization.
- Long-term outcome determinants for MIDCAB require further investigation.
Purpose of the Study:
- To retrospectively analyze long-term survival and freedom from cardiac events after MIDCAB.
- To identify factors influencing long-term outcomes in MIDCAB patients.
Main Methods:
- Retrospective analysis of 109 patients undergoing MIDCAB between 1997 and 2005.
- Follow-up averaged 50.7 months, with 100% completion.
- Multivariable Cox regression analysis identified predictors of long-term outcomes.
Main Results:
- High early patency rates (94.7%) and excellent survival (95.8% at 5 years).
- Long-term freedom from revascularization was 88.3% at 5 years.
- Female sex and left ventricular dysfunction were significant predictors of adverse cardiac outcomes.
Conclusions:
- Appropriate patient selection is key for successful long-term MIDCAB outcomes.
- Female patients require special consideration due to higher risks of adverse events and repeat revascularization.
- MIDCAB is a viable option for specific multivessel disease scenarios or hybrid approaches.
Aim:
Minimally invasive direct coronary artery bypass (MIDCAB) is a reliable method to revascularize the left anterior descending (LAD) coronary artery. However, a more consistent body of knowledge is needed to assess factors influencing long-term outcome. With this study, we retrospectively investigated the long-term determinants of survival and freedom from cardiac morbidity and revascularization in patients who underwent MIDCAB.
Methods:
From 1997 to 2005, 109 patients underwent MIDCAB. Seventy-five (68.8%) presented isolated LAD disease and 34 (31.2%) multivessel disease. The first 57 patients (53.2%) in the series underwent early postoperative angiographic reinvestigation. All 109 patients were subsequently followed-up at our outpatient clinic. Follow-up (mean 50.7 months, range 3-93) was completed in 100% of cases.
Results:
No in-hospital deaths occurred; 2 patients (1.8%) experienced perioperative myocardial infarction. At early postoperative angiographic reinvestigation, the anastomotic perfect patency rate was 54/57 (94.7%); survival was 100% and 95.8% at 1 and 5 years, respectively. Overall freedom from repeated revascularization was 95.3% and 88.3% at 1 and 5 years respectively; freedom from LAD revascularization was 95.3% and 91.6% at 1 and 5 years, respectively; cardiac event-free survival was 95.3% and 80.8% at 1 and 5 years respectively. At multivariable analysis (Cox regression), women were found to have a higher risk of repeated LAD revascularization (hazard ratio [HR] 30.24; P<0.001); female sex and left ventricular dysfunction were the only predictors affecting long-term cardiac outcome (hazard ratio 29.35; P<0.001 and 5.1; P<0.001), respectively.
Conclusions:
A key factor in the long-term success of MIDCAB seems to be appropriate patient selection. Special attention should be reserved for female patients, as they appear to have a worse cardiac outcome and a higher probability of repeated revascularization on LAD. MIDCAB may represent a viable option for treating multivessel disease when complete revascularization is unfeasible or a hybrid procedure is envisaged.
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