Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease
Grischa Hoffmann1, Christine Friedrich1, Katharina Huenges1
1Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) grafting offers acceptable early outcomes for high-risk patients with multivessel disease (MVD). This approach provides a viable alternative to traditional surgery, showing better-than-predicted results and satisfying midterm survival rates.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Risk Assessment
Background:
- High-risk patients with multivessel disease (MVD) often face challenges with traditional coronary artery bypass grafting (CABG) due to invasiveness and complications.
- Minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR) present potential alternatives for these complex cases.
Purpose of the Study:
- To evaluate the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in high-risk MVD patients undergoing MIDCAB or HCR.
- To assess the early and midterm outcomes of MIDCAB in a cohort of high-risk patients.
Main Methods:
- Defined high-risk as a logistic European System for Cardiac Operative Risk Evaluation (logES) score >10%.
- Retrospectively analyzed 78 high-risk MVD patients (logES: 18.5%) who underwent MIDCAB between 1998 and 2015.
- Evaluated 30-day and midterm outcomes, including MACCEs and survival rates.
Main Results:
- The 30-day mortality and MACCE rate was 9.0%, with early mortality being twofold overestimated by logES.
- Complete revascularization was achieved in 82.1% of patients.
- Median follow-up was 3.4 years, with 1, 3, and 5-year survival rates of 77%, 62%, and 48%, respectively.
Conclusions:
- MIDCAB demonstrates acceptable early outcomes in high-risk MVD patients, outperforming predictions based on logES.
- Midterm follow-up shows satisfying survival rates, despite incomplete realization of scheduled HCR in some cases.
- MIDCAB is a suitable alternative for selected high-risk MVD patients when considering invasiveness and perioperative risks.
Background:
High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR).
Methods:
A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated.
Results:
Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2-6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%.
Conclusion:
In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.
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