Vol 28, No 1 (2021)
Original Article
Published online: 2019-01-30

open access

Page views 1568
Article views/downloads 1272
Get Citation

Connect on Social Media

Connect on Social Media

Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis

Rafik Abusamra12, Marek Król3, Krzysztof Milewski34, Mateusz Kachel3, Loai Abudaqa5, Justyna Jankowska-Sanetra3, Kamil Derbisz3, Krzysztof Sanetra3, Anna Sobieszek3, Piotr P. Buszman3, Wojciech Wojakowski2, Paweł E. Buszman23, Andrzej Bochenek32, Marek Cisowski32
Pubmed: 30701513
Cardiol J 2021;28(1):86-94.


Background: To perform a retrospective analysis of patients who underwent endoscopic atraumatic
coronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years.

Methods: Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998–2002 (group 1), 2003–2005 (group 2), 2006–2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted.

Results: The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99%
of all patients. No mortality was observed up to 30 days. Complications in the early period included
pleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and wound
infection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%)
patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency of
major adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and
85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR:
3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63)
influenced the incidence rate.

Conclusions: The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The elimination
of cardiopulmonary bypass significantly reduces the number of complications.

Article available in PDF format

View PDF Download PDF file


  1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64(24): e139–e228.
  2. Dieberg G, Smart NA, King N. Minimally invasive cardiac surgery: A systematic review and meta-analysis. Int J Cardiol. 2016; 223: 554–560.
  3. Cisowski M. Miniinwazyjne pomostowanie gałęzi międzykomorowej przedniej lewej tętnicy wieńcowej z wykorzystaniem techniki wideoskopowej. Rozprawa habilitacyjna. SUM, Katowice. 2004.
  4. Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35(37): 2541–2619.
  5. Wang XW, Qu C, Huang C, et al. Minimally invasive direct coronary bypass compared with percutaneous coronary intervention for left anterior descending artery disease: a meta-analysis. J Cardiothorac Surg. 2016; 11(1): 125.
  6. Benedetto U, Raja SG, Soliman RFB, et al. Minimally invasive direct coronary artery bypass improves late survival compared with drug-eluting stents in isolated proximal left anterior descending artery disease: a 10-year follow-up, single-center, propensity score analysis. J Thorac Cardiovasc Surg. 2014; 148(4): 1316–1322.
  7. Yang M, Xiao LB, Gao ZS, et al. Clinical effect and prognosis of off-pump minimally invasive direct coronary artery bypass. Med Sci Monit. 2017; 23: 1123–1128.
  8. Hong SJ, Lim DS, Seo HS, et al. Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. Catheter Cardiovasc Interv. 2005; 64(1): 75–81.
  9. Fihn S, Gardin J, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol. 2012; 60(24): e44–e164.
  10. Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017; 69(17): 2212–2241.
  11. Holzhey DM, Jacobs S, Mochalski M, et al. Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients. Ann Thorac Surg. 2007; 83(1): 108–114.
  12. Hoffmann G, Friedrich C, Barrabas M, et al. Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarians. Interact Cardiovasc Thorac Surg. 2016; 23(3): 377–382.
  13. Kozower BD, Moon MR, Barner HB, et al. Impact of complete revascularization on long-term survival after coronary artery bypass grafting in octogenarians. Ann Thorac Surg. 2005; 80(1): 112–116.
  14. Graham MM, Norris CM, Galbraith PD, et al. APPROACH Investigators. Quality of life after coronary revascularization in the elderly. Eur Heart J. 2006; 27(14): 1690–1698.
  15. Blazek S, Rossbach C, Borger MA, et al. Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. JACC Cardiovasc Interv. 2015; 8(1 Pt A): 30–38.
  16. Deppe AC, Liakopoulos OJ, Kuhn EW, et al. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients. Eur J Cardiothorac Surg. 2015; 47(3): 397–406; discussion 406.
  17. Buszman PP, Krol M, Cisowski M, et al. DES vs MIDCAB for proximal LAD disease: long term registry results. J Am Coll Cardiol. 2011; 58: B53.
  18. Nataf P, Al-Attar N, Ramadan R, et al. Thoracoscopic IMA takedown. J Card Surg. 2000; 15(4): 278–282.
  19. Nataf P, Lima L, Regan M, et al. Minimally invasive coronary surgery with thoracoscopic internal mammary artery dissection: surgical technique. J Card Surg. 1996; 11(4): 288–292.
  20. Sabashnikov A, Patil NP, Weymann A, et al. Outcomes after different non-sternotomy approaches to left single-vessel revascularization: a comparative study with up to 10-year follow-up. Eur J Cardiothorac Surg. 2014; 46(4): e48–e55.