Minimally invasive coronary artery bypass: Twenty-year experience
| Autor: | Alberto Repossini, Alessandra Stara, Flavia Nicoli, Lorenzo Di Bacco, Claudio Muneretto, Bruno Passaretti, Bejko Jonida |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Hybrid coronary revascularization medicine.medical_treatment Coronary Disease long-term follow-up Kaplan-Meier Estimate 030204 cardiovascular system & hematology hybrid revascularization law.invention Angina 03 medical and health sciences Thoracic Arteries 0302 clinical medicine Interquartile range law medicine Cardiopulmonary bypass Humans Minimally Invasive Surgical Procedures coronary artery revascularization Coronary Artery Bypass Aged Retrospective Studies business.industry MIDCAB Percutaneous coronary intervention medicine.disease Survival Analysis Confidence interval Surgery medicine.anatomical_structure 030228 respiratory system Drug-eluting stent Female Cardiology and Cardiovascular Medicine business Artery |
| Popis: | Objective Minimally invasive direct coronary artery bypass for the left thoracic artery on the left anterior descending artery is a safe and less traumatic surgical technique. We retrospectively evaluated long-term outcomes in a large series of patients undergoing minimally invasive direct coronary artery bypass. Methods From 1997 to 2016, 1060 patients underwent minimally invasive direct coronary artery bypass: 646 patients (61%) with isolated proximal left anterior descending disease and 414 patients (39%) with multivessel disease as a part of hybrid coronary revascularization or in association with medical therapy. Long-term follow-up, major cardiac and cerebral adverse events, and freedom from angina were analyzed. Results Mean age of patients was 71 ± 12.5 years, and median European System for Cardiac Operative Risk Evaluation II was 3.2% (interquartile range, 0.6%-7.8%). Postoperative death occurred in 9 patients (0.8%), and perioperative stroke occurred in 3 patients (0.3%). An angiogram or computed tomography scan was performed and was available in patients within 10 years of follow-up (n = 696), demonstrating a 96.8% graft patency rate. At 13.9 ± 5.6 years of follow-up, no surgical reintervention was performed for left thoracic artery on left anterior descending artery graft failure, but 14 patients underwent left anterior descending or left thoracic artery on left anterior descending artery percutaneous coronary intervention. Kaplan–Meier survival curve shows 87.1% at 5 years (95% confidence interval, 81-92.5), 84.3% at 10 years (95% confidence interval, 77.1-91.4), and 79.8% at 15 years (95% confidence interval, 72.2-87.3). Survival freedom from major adverse events was 87.0% (95% confidence interval, 85.9-88.1) at 5 years and 70.5% (95% confidence interval, 66.4-74.6) at 15 years. Conclusions Minimally invasive direct coronary artery bypass can be safely performed with low postoperative mortality and morbidity with excellent short- and long-term survival and freedom from major adverse events and angina with a reduced surgical invasiveness. |
| Databáze: | OpenAIRE |
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