Long-Term Clinical and Computed Tomography Angiographic Follow-up After Totally Endoscopic Coronary Artery Bypass Grafting

Innovations (Phila). 2018 Jan/Feb;13(1):5-10. doi: 10.1097/IMI.0000000000000461.

Abstract

Objective: Totally endoscopic coronary artery bypass grafting was shown to be feasible and safe, with excellent clinical and angiographic mid-term results. Data on long-term outcome are lacking. Therefore, we aimed to investigate the long-term rate of major adverse cardiac and cerebrovascular events and left internal mammary artery patency rate in patients undergoing arrested heart totally endoscopic coronary artery bypass grafting.

Methods: From 2001 to 2012, a total of 208 arrested heart-totally endoscopic coronary artery bypass grafting patients were prospectively included. Mean ± SD age was 58.8 ± 9.4 years, and mean ± SD Society of Thoracic Surgeons score was 0.5 ± 0.5%. Major adverse cardiac and cerebrovascular events were defined as a composite of death, myocardial infarction, stroke, re-percutaneous coronary intervention, re-coronary artery bypass graft, and target vessel revascularization. Left internal mammary artery patency was assessed using cardiac computed tomography and depicted according to the established Fitzgibbon classification. Mean ± SD follow-up was 6.9 ± 2.3 years.

Results: At 1, 5, and 10 years, survival rate was 100%, 98.3%, and 95.8%, respectively. The freedom from clinical events at 1, 5, and 10 years were major adverse cardiac and cerebrovascular events (93.5%, 85.9%, and 83.0%), myocardial infarction (99.0%, 97.4%, and 95.9%), target vessel revascularization (96.0%, 94.3%, and 91.7%), re-percutaneous coronary intervention (94.5%, 91.6%, and 84.2%), and re-coronary artery bypass graft (100%, 99.5%, and 99.5%), respectively. Left internal mammary artery patency rate at 1, 5, and 10 years was 100%, 94.9%, and 88.1%, respectively.

Conclusions: Arrested heart-totally endoscopic coronary artery bypass grafting shows excellent clinical long-term results with a left internal mammary artery patency rate comparable with conventional coronary artery bypass graft at 10 years after surgery.

MeSH terms

  • Aged
  • Computed Tomography Angiography / methods*
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / methods*
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Disease / surgery*
  • Endoscopy / instrumentation*
  • Female
  • Follow-Up Studies
  • Heart / diagnostic imaging
  • Humans
  • Internal Mammary-Coronary Artery Anastomosis / methods
  • Male
  • Mammary Arteries / diagnostic imaging
  • Mammary Arteries / pathology
  • Mammary Arteries / transplantation*
  • Middle Aged
  • Myocardial Infarction / complications
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Prospective Studies
  • Robotic Surgical Procedures / methods
  • Stroke / complications
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Vascular Patency / physiology