Abstract
BackgroundThe aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB).MethodsOver a decade, 160 eligible patients for elective LAD bypass were referred to one of the three techniques: 48 PA-CABG, 53 MIDCAB and 59 TECAB. In MIDCAB group, Euroscore was higher and target vessel quality was worse. In TECAB group, early patency was systematically evaluated using coronary CT scan. During follow-up (mean 2.7 ± 0.1 years, cumulated 438 years) symptom-based angiography was performed.ResultsThere was no conversion from off-pump to on-pump procedure or to sternotomy approach. In TECAB group, there was one hospital cardiac death (1.7%), reoperation for bleeding was higher (8.5% vs 3.7% in MIDCAB and 2% in PA-CABG) and 3-month LAD reintervention was significantly higher (10% vs 1.8% in MIDCAB and 0% in PA-CABG). There was no difference between MIDCAB and PA-CABG groups. During follow-up, symptom-based angiography (n = 12) demonstrated a good patency of LAD bypass in all groups and 4 patients underwent a no LAD reintervention. At 3 years, there was no difference in survival; 3-year angina-free survival and reintervention-free survival were significantly lower in TECAB group (TECAB, 85 ± 12%, 88 ± 8%; MIDCAB, 100%, 98 ± 5%; PA-CABG, 94 ± 8%, 100%; respectively).ConclusionsOur study confirmed that minimally invasive LAD grafting was safe and effective. TECAB is associated with a higher rate of early bypass failure and reintervention. MIDCAB is still the most reliable surgical technique for isolated LAD grafting and the least cost effective.
Highlights
The aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB)
For several decades, left internal thoracic artery (LITA) bypass grafting has been recognised as the gold standard for left anterior descending coronary artery (LAD) revascularization and its beneficial impact was demonstrated in conventional coronary artery bypass grafting (CABG)
We report our experience in minimally invasive LAD grafting with a comparative analysis between PA-CABG, MIDCAB and off-pump TECAB, in order to answer the question: is there an optimal minimally invasive technique for isolated LAD grafting?
Summary
From January 1998 to December 2008, 160 eligible patients for elective LAD revascularization were referred to minimally invasive CABG surgery. There were two surgical periods: from January1998 to September 2003, the intend-totreat surgical procedure was either PA-CABG or MIDCAB depending on the patient’s condition, and after the purchase of standard Da Vinci robotic system in September 2003, the intend-to-treat surgical procedure was either off-pump TECAB or robotic enhanced MIDCAB depending on the patient’s condition In this series, the patients were categorized into three groups according to the surgical procedure performed: PA-CABG (n = 48), MIDCAB (n = 53), TECAB (n = 59). Thoracotomy; myocardial stabilization was obtained with an Estech stabilizer; a proximal LAD occlusion was performed using 4-0 ePTFE sutures; the anastomosis was done under direct vision with intra-coronary shunt and 8-0 Prolene running suture. Myocardial stabilization was done using an Octopus TE endoscopic stabilizer (Medtronic Inc.), placed either before or after the mini-thoracotomy, and the anastomosis was performed according to the same rules with proximal LAD occlusion, intracoronary shunt and running suture. A log-rank test was used to compare Kaplan-Meier curves of survival and freedom from event
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