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Published on: August 28, 2018
Long-Term Clinical and Computed Tomography Angiographic Follow-up After Totally Endoscopic Coronary Artery Bypass
Insights
Arrested heart-totally endoscopic coronary artery bypass grafting demonstrates excellent long-term survival and graft patency. This minimally invasive approach offers durable outcomes comparable to conventional surgery for coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Totally endoscopic coronary artery bypass grafting (TECAB) shows mid-term feasibility and safety.
- Long-term outcomes data for TECAB, particularly the arrested heart technique, are limited.
- Assessing long-term major adverse cardiac and cerebrovascular events (MACCE) and graft patency is crucial.
Purpose of the Study:
- To evaluate the long-term rate of MACCE after arrested heart-TECAB.
- To determine the long-term patency rate of the left internal mammary artery (LIMA) graft in TECAB patients.
- To provide long-term outcome data for this minimally invasive surgical approach.
Main Methods:
- Prospective inclusion of 208 patients undergoing arrested heart-TECAB between 2001 and 2012.
- Definition of MACCE as death, myocardial infarction, stroke, re-PCI, re-CABG, or TVR.
- Assessment of LIMA patency using cardiac computed tomography and the Fitzgibbon classification.
Main Results:
- Survival rates at 1, 5, and 10 years were 100%, 98.3%, and 95.8%, respectively.
- Long-term freedom from MACCE was 83.0% at 10 years, with high rates of graft patency (88.1% at 10 years).
- LIMA patency remained high, with 88.1% patency at 10 years, comparable to conventional CABG.
Conclusions:
- Arrested heart-TECAB provides excellent long-term clinical outcomes.
- The LIMA patency rate at 10 years is comparable to conventional coronary artery bypass graft surgery.
- TECAB is a viable and durable surgical option for coronary artery disease treatment.
Objective:
Totally endoscopic coronary artery bypass grafting was shown to be feasible and safe, with excellent clinical and angiographic mid-term results. Data on long-term outcome are lacking. Therefore, we aimed to investigate the long-term rate of major adverse cardiac and cerebrovascular events and left internal mammary artery patency rate in patients undergoing arrested heart totally endoscopic coronary artery bypass grafting.
Methods:
From 2001 to 2012, a total of 208 arrested heart-totally endoscopic coronary artery bypass grafting patients were prospectively included. Mean ± SD age was 58.8 ± 9.4 years, and mean ± SD Society of Thoracic Surgeons score was 0.5 ± 0.5%. Major adverse cardiac and cerebrovascular events were defined as a composite of death, myocardial infarction, stroke, re-percutaneous coronary intervention, re-coronary artery bypass graft, and target vessel revascularization. Left internal mammary artery patency was assessed using cardiac computed tomography and depicted according to the established Fitzgibbon classification. Mean ± SD follow-up was 6.9 ± 2.3 years.
Results:
At 1, 5, and 10 years, survival rate was 100%, 98.3%, and 95.8%, respectively. The freedom from clinical events at 1, 5, and 10 years were major adverse cardiac and cerebrovascular events (93.5%, 85.9%, and 83.0%), myocardial infarction (99.0%, 97.4%, and 95.9%), target vessel revascularization (96.0%, 94.3%, and 91.7%), re-percutaneous coronary intervention (94.5%, 91.6%, and 84.2%), and re-coronary artery bypass graft (100%, 99.5%, and 99.5%), respectively. Left internal mammary artery patency rate at 1, 5, and 10 years was 100%, 94.9%, and 88.1%, respectively.
Conclusions:
Arrested heart-totally endoscopic coronary artery bypass grafting shows excellent clinical long-term results with a left internal mammary artery patency rate comparable with conventional coronary artery bypass graft at 10 years after surgery.
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