Which place for Port Access surgery in coronary artery bypass grafting? A mid-term follow up study

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
• Minimally invasive approaches aim to reduce surgical trauma and improve patient recovery.
• Port Access CABG utilizes cardiopulmonary bypass (CPB) via peripheral cannulation and smaller incisions.

Purpose of the Study:

• To evaluate the safety and efficacy of Port Access CABG using the Heartport endoCPB system.
• To assess mid-term clinical outcomes and graft patency in patients with one or two-vessel disease.

Main Methods:

• A prospective study of 68 patients with one or two-vessel disease undergoing Port Access CABG between May 1997 and November 2002.
• Utilized the Heartport endoCPB system with various graft conduits, including internal thoracic arteries and radial artery.
• Collected data on operative times, CPB duration, postoperative recovery, clinical outcomes, and graft patency at mid-term follow-up.

Main Results:

• Mean operative time was 3.8 hours, with cross-clamping and CPB times of 42 and 64 minutes, respectively.
• Postoperative outcomes included short ventilation times (11 hours), ICU stay of 1.9 days, and low blood loss (398 ml).
• Significant reduction in Canadian Cardiovascular Society (CCS) score (3.1 to 1.1, P<0.0001) and patent grafts in all cases at 4.1 years follow-up.

Conclusions:

• Port Access CABG is a safe and effective surgical option for selected patients with one or two-vessel coronary artery disease.
• The technique provides stable mid-term results, characterized by symptom improvement and durable graft patency.
• Minimally invasive CABG can be considered a viable alternative to conventional sternotomy for appropriate patient populations.