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

Rafik Abusamra, Marek Król, Krzysztof Milewski, Mateusz Kachel, Loai Abudaqa, Justyna Jankowska-Sanetra, Kamil Derbisz, Krzysztof Sanetra, Anna Sobieszek, Piotr P. Buszman, Wojciech Wojakowski, Paweł E. Buszman, Andrzej Bochenek, Marek Cisowski
DOI: 10.5603/CJ.a2019.0006
·
Pubmed: 30701513

open access

Ahead of print
Original articles
Published online: 2019-01-30

Abstract

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; Mdn: 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 cardio-vascular 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.

Abstract

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; Mdn: 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 cardio-vascular 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.

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Keywords

endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB), minimally invasive surgery, left anterior descending coronary artery stenosis, minimally invasive direct coronary artery bypass grafting (MIDCAB)

About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-01-30

DOI

10.5603/CJ.a2019.0006

Pubmed

30701513

Keywords

endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB)
minimally invasive surgery
left anterior descending coronary artery stenosis
minimally invasive direct coronary artery bypass grafting (MIDCAB)

Authors

Rafik Abusamra
Marek Król
Krzysztof Milewski
Mateusz Kachel
Loai Abudaqa
Justyna Jankowska-Sanetra
Kamil Derbisz
Krzysztof Sanetra
Anna Sobieszek
Piotr P. Buszman
Wojciech Wojakowski
Paweł E. Buszman
Andrzej Bochenek
Marek Cisowski

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