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Published on: April 18, 2013
MIDCAB characteristics and results: the CardioThoracic Systems (CTS) registry
R Holubkov1, M Zenati, J J Akin
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. holubkov@edc.gsph.pitt.edu
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) surgery using CTS instrumentation demonstrated safety and acute success in a large patient cohort. Further clinical trials are needed to identify optimal patient candidates and long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is a surgical technique for treating coronary artery disease.
- The CardioThoracic Systems (CTS) registry was established to evaluate MIDCAB procedures.
Purpose of the Study:
- To examine baseline patient characteristics for MIDCAB.
- To document procedural details, including grafting techniques and complications.
- To assess post-operative graft patency in MIDCAB patients.
Main Methods:
- Analysis of 508 consecutive patients undergoing MIDCAB with CTS instrumentation.
- Data collected from 35 international centers between April 1996 and March 1997.
- Evaluation of patient demographics, surgical techniques, complications, and graft patency.
Main Results:
- The average patient age was 63 years, with 27% women. Left internal mammary artery was the predominant graft (93%).
- In-hospital complication rates were low: 0.6% mortality, 5.5% redo/reintervention. 92% of patients were event-free at discharge.
- Post-operative angiography in 83 patients showed 94% graft patency.
Conclusions:
- MIDCAB using CTS instrumentation is safe and achieves acute success in most patients.
- Further comparative studies and clinical trials are necessary.
- Longer-term outcomes and identification of ideal patient populations require further investigation.
Objective:
The CardioThoracic Systems (CTS) registry of minimally invasive direct coronary artery bypass (MIDCAB) was established to examine baseline characteristics of patients undergoing this surgical procedure, document details of the procedures including grafting techniques and post-operative complication rates, and assess post-operative graft patency.
Methods:
A total of 508 consecutive patients who had MIDCAB using CTS instrumentation between April 1996 and March 1997 at 35 international centers were analyzed.
Results:
The mean age of patients, 27% of whom were women, was 63 years. Eight percent had previous coronary artery bypass surgery. While nearly all patients had significant stenoses in the left anterior descending artery, 23% had disease in two vessels and 9% in three vessels. Almost all procedures used the left internal mammary artery, with 7% employing multiple or sequential grafts. The entire surgical procedure lasted on average 135 min (median 2 h), with a mean time of 14 min to perform anastomosis. Surgical approaches, including anastomosis technique and method used to maintain bloodless field, varied widely across clinical centers. In-hospital complication rates were relatively low, with 0.6% mortality (0% perioperative), 1.2% conversion to sternotomy with cardiopulmonary bypass, 1.4% conversion to sternotomy without bypass, and 5.5% redo or reintervention. In total, 92% of patients were free from all of these events at hospital discharge; women showed a strong trend toward increased risk for major in-hospital events compared with men. Rib fracture was the most common complication, reported in 12% of patients. Post-operative angiography, performed in 83 patients at an average 2.2 days post-procedure, found full patency in 78 (94%).
Conclusions:
The CTS registry data indicates that in the great majority of patients, MIDCAB using CTS instrumentation was performed safely and with acute success. Comparative studies, most importantly clinical trials, are needed to determine the types of patients who benefit most from this procedure, as well as its longer-term outcome.
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