High-Risk Patients with Multivessel Disease—Is There a Role for Incomplete Myocardial Revascularization via Minimally Invasive Direct Coronary Artery Bypass Grafting?

Abstract

Patients with multivessel disease with high predicted mortality for conventional coronary artery bypass grafting (CABG) and the left anterior descending coronary artery (LAD) as the major target vessel may be suitable for minimally invasive direct coronary artery bypass (MIDCAB) despite incomplete revascularization. From January 1997 to December 2005, MIDCAB was performed in 80 patients (mean age 70 +/- 11.3 years) with multivessel disease. Predicted mortality was 10.2% calculated by the logistic Euroscore. Results were analyzed retrospectively for mortality, morbidity, operation time, and event-free survival, including freedom from angina, major adverse cardiac events (MACE), and reintervention. Mean operating time was 100 +/- 31 minutes. There was one in-hospital death (1.25%). Four patients (5%) had to be reoperated on, 2 via the minithoracotomy incision and 2 via sternotomy. Follow-up was completed in 87% of patients. During follow-up (26 months), 9 patients died. The cause of death was cardiac in 1 patient, noncardiac in 3 patients, and unknown in 5 patients. Two patients required reoperation because of progressive atherosclerosis, and 2 patients because of progressive valve disease. The actuarial 4-year survival was 85.6% (95% confidence interval [CI], 72%-99%) and the event-free survival including freedom from angina, MACE, and reintervention was 81.5% [95% CI, 68%-96%]. Incomplete revascularization via MIDCAB is a safe and effective procedure in selected patients with multivessel disease. Compared to conventional CABG in high-risk patients, MIDCAB carries a lower incidence of inhospital death, neurological events, and perioperative myocardial infarction with comparable midterm results.