TY - JOUR
T1 - Very long-term outcome of Minimally Invasive Direct Coronary Artery Bypass
AU - Mastroiacovo, Giorgio
AU - Manganiello, Sabrina
AU - Pirola, Sergio
AU - Tedesco, Calogero
AU - Cavallotti, Laura
AU - Antona, Carlo
AU - Alamanni, Francesco
AU - Pompilio, Giulio
N1 - Copyright © 2020. Published by Elsevier Inc.
PY - 2020/8/17
Y1 - 2020/8/17
N2 - BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) is a well-established low-impact surgical procedure for revascularization of left descending coronary artery with the left internal mammary artery. This work aims to evaluate safety, overall survival and freedom from major adverse cardio-cerebral events (MACCE) after 20 years of MIDCAB.METHODS: We retrospectively collected a series of 141 patients who underwent MIDCAB between 1997 and 2017 to assess long-term outcome. Therefore, we analysed 133 patients who consequently underwent revascularization of left descending coronary artery with left mammary artery via a full median sternotomy.RESULTS: Actuarial survival rate at Kaplan-Meier curve was 100%, 95%, 90%, 83% and 70% at 1, 5, 10, 15 and 20 years, respectively. Freedom from MACCE, defined as myocardial infarction, stroke and cardiac death, was 97%, 90%, 79%, 75% and 61% at 1,5,10,15 and 20 years, respectively. At Cox multivariable analysis, age, cancer and chronic renal insufficiency have been found to be independent predictors affecting long-term survival, with a hazard ratio of 1,12 (p 0.007), 17,63 (p<0.001) and 5.16 (p 0.03), respectively. MIDCAB group showed a significantly lower rate of in-hospital stay, blood transfusions, cardiac-related and all-causes events compared to full sternotomy group (p=0,02 and p=0,0001, respectively).CONCLUSIONS: Very long-term clinical outcome of MIDCAB is satisfactory in terms of survival and freedom from MACCE. MIDCAB significantly reduces in-hospital stay and blood transfusions when compared to full sternotomy bypass surgery on left descending coronary artery and appears to effectively improve prognosis in terms of cardiac- and all-causes events.
AB - BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) is a well-established low-impact surgical procedure for revascularization of left descending coronary artery with the left internal mammary artery. This work aims to evaluate safety, overall survival and freedom from major adverse cardio-cerebral events (MACCE) after 20 years of MIDCAB.METHODS: We retrospectively collected a series of 141 patients who underwent MIDCAB between 1997 and 2017 to assess long-term outcome. Therefore, we analysed 133 patients who consequently underwent revascularization of left descending coronary artery with left mammary artery via a full median sternotomy.RESULTS: Actuarial survival rate at Kaplan-Meier curve was 100%, 95%, 90%, 83% and 70% at 1, 5, 10, 15 and 20 years, respectively. Freedom from MACCE, defined as myocardial infarction, stroke and cardiac death, was 97%, 90%, 79%, 75% and 61% at 1,5,10,15 and 20 years, respectively. At Cox multivariable analysis, age, cancer and chronic renal insufficiency have been found to be independent predictors affecting long-term survival, with a hazard ratio of 1,12 (p 0.007), 17,63 (p<0.001) and 5.16 (p 0.03), respectively. MIDCAB group showed a significantly lower rate of in-hospital stay, blood transfusions, cardiac-related and all-causes events compared to full sternotomy group (p=0,02 and p=0,0001, respectively).CONCLUSIONS: Very long-term clinical outcome of MIDCAB is satisfactory in terms of survival and freedom from MACCE. MIDCAB significantly reduces in-hospital stay and blood transfusions when compared to full sternotomy bypass surgery on left descending coronary artery and appears to effectively improve prognosis in terms of cardiac- and all-causes events.
U2 - 10.1016/j.athoracsur.2020.06.025
DO - 10.1016/j.athoracsur.2020.06.025
M3 - Article
C2 - 32818539
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
ER -