Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: the Leipzig experience

Davierwala, P. M., Verevkin, A., Bergien, L., von Aspern, K., Deo, S. V. , Misfeld, M., Holzhey, D. and Borger, M. A. (2023) Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: the Leipzig experience. Journal of Thoracic and Cardiovascular Surgery, 165(1), 115-127.e4. (doi: 10.1016/j.jtcvs.2020.12.149) (PMID:33757682)

Abstract

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality. Methods: A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods. Results: The mean age was 64.5 ± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I = 4.9 ± 6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I = 3.1 ± 4.5) and B (log EuroSCORE I = 3.5 ± 4.7). Overall and groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .7), respectively. Overall 10-, 15-, and 20-year survival estimates for all patients were 77.7 ± 0.9%, 66.1 ± 1.2%, and 55.6 ± 1.6%, respectively. Conclusions: MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Deo, Salil
• Authors: Davierwala, P. M., Verevkin, A., Bergien, L., von Aspern, K., Deo, S. V., Misfeld, M., Holzhey, D., and Borger, M. A.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Journal of Thoracic and Cardiovascular Surgery
• Publisher: Elsevier
• ISSN: 0022-5223
• ISSN (Online): 1097-685X
• Published Online: 17 February 2021