Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis
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; 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.
Keywords: endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB)minimally invasive surgeryleft anterior descending coronary artery stenosisminimally invasive direct coronary artery bypass grafting (MIDCAB)
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