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Published on: October 20, 2017
Results after MIDCAB and OPCAB surgeries: problems and consequences of incomplete angiographic follow-up in the
Ernst Weigang1, Johannes Royl, Andreas Dencker
1Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. weigang@ch11.ukl.uni-freiburg.de
Insights
Minimally invasive coronary artery bypass grafting (CABG) on a beating heart shows encouraging mid-term survival and improved quality of life. Incomplete angiographic follow-up may negatively bias graft patency results.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Minimally invasive coronary artery bypass grafting (CABG) offers an alternative to conventional surgery.
- Off-pump CABG procedures performed without cardiopulmonary bypass aim to reduce complications.
- Evaluating the long-term outcomes of these procedures is crucial for patient management.
Purpose of the Study:
- To assess the mid-term clinical course of patients undergoing minimally invasive CABG.
- To evaluate perioperative complications, quality of life, graft patency, and survival.
- To investigate the impact of incomplete angiographic follow-up on study results.
Main Methods:
- Retrospective analysis of patients who underwent off-pump CABG between 1996 and 2001.
- Procedures utilized median sternotomy or anterolateral thoracotomy for access.
- Follow-up included clinical assessment, quality of life questionnaires, and recommended angiographic controls.
Main Results:
- 100% survival at 30 days, with 2% experiencing perioperative myocardial infarction requiring reoperation.
- Mean follow-up of 25 months showed significant improvement in NYHA and CCS classes.
- Graft patency was 89% for evaluated anastomoses; however, incomplete angiographic follow-up (46/89 patients) potentially biased results.
Conclusions:
- Minimally invasive off-pump CABG demonstrates encouraging mid-term survival and improved clinical status.
- Challenges in achieving complete angiographic follow-up can influence the interpretation of graft patency.
- The study highlights the importance of consistent follow-up for accurate outcome assessment in minimally invasive cardiac surgery.
Objective:
The aim of this study was to evaluate the mid-term course of all patients who had undergone minimally invasive coronary artery bypass grafting in our department between January 1996 and September 2001. The procedures were performed on the beating heart without the use of cardiopulmonary bypass. Either median sternotomy (60 patients) or anterolateral thoracotomy (29 patients) was used for access. Evaluation focused on perioperative complications, quality of life, clinical status, graft patency, survival and freedom from cardiac events. Special emphasis was put on the problems and consequences of incomplete angiographic follow-up.
Methods:
Survival and postoperative cardiac events of all patients were evaluated. All surviving patients were invited for follow-up examination. Angiographic control was recommended to all patients.
Results:
Survival after 30 days was 100%. Two patients (2%) suffered from perioperative myocardial infarction due to early graft failure, which required reoperation in standard technique in both cases. Mean follow-up period was 25 months. Mean NYHA class improved from preoperative 2.3 to current 1.6, and the mean CCS class from 2.1 to 0.8. Angiographic controls were performed in 46/89 patients. Fifty-three anastomoses were evaluated, 47 of which showed no occlusion (patency rate 89%). Forty-two anastomoses (79%) were free of significant stenosis. In 27 patients without symptoms we recommended angiography for control purposes and observed a patency rate of 97%. Nineteen patients had already undergone angiographic control due to clinical complaints prior to follow-up examination. That group's graft patency rate was 78%. Survival was 98% after 1 year and 94% after 3 years. Survival free of cardiac events (myocardial infarction, reoperation, percutaneous transluminal coronary angioplasty) was 86% in the first year and 80% after 3 years.
Conclusions:
The results concerning survival, freedom from events, and clinical status are encouraging. It was not possible to perform angiographic controls in all patients since some of them and their primary physicians could not be convinced of the necessity of this control in the absence of clinical complaints. This explains the negative bias in our results.
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