Five-Year Survival of Patients Treated with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Compared with the General Swiss Population

Abstract

Background To evaluate the midterm follow-up and 5-year survival outcome of the minimally invasive direct coronary artery bypass (MIDCAB) procedure compared with the survival of the general Swiss population. Methods Retrospective study on preoperative data, intraoperative data, and postoperative outcome of patients who underwent MIDCAB surgery between June 2010 and February 2019. To assess validity of this surgical therapy, outcomes were compared with survival data of a gender- and age-matched cohort of the general Swiss population taken from the database of the Swiss Federal Statistical Office. Results A total of 88 patients were included. Median (interquartile range [IQR[) age was 66 (56–75) years, and 27% (n = 24) were female. The median (IQR) length of the in-hospital stay was 7 (6–8) days. No postoperative stroke occurred. The 30-day mortality was 1.1% (n = 1). Reintervention for failed left internal mammary artery was needed in 1.1% (n = 1). The median (IQR) ejection fraction was 58% (47–60) preoperatively and remained stable during follow-up. The median (IQR) follow-up period was 3 (1.1–5.2) years. Five years postoperatively, 83% (confidence interval, 69–91) of the patients were alive, showing an overlap with the range of survival of the matched subcohort of the general Swiss population (range, 84–100%). Conclusion Though suffering from coronary heart disease, patients after MIDCAB show almost equal survival rates as an equivalent subcohort corresponding to the general Swiss population matched on age and gender. Thus, our data show this treatment to be safe and beneficial.

Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience

“…Previously published studies reported comparable stroke and myocardial infarction (MI) rates between conventional CABG and minimally invasive approaches verifying its safety [ 15 ]. In line with previous evidence [ 8 , 10 , 16 ], our study reports no cases of perioperative stroke, no cases of new-onset dialysis, and only two cases (0.64%) of perioperative MI. In our study, we present seven cases (2.3%) of newly manifested AF, which is favorable compared to previously reported rates [ 8 , 16 ].…”

“…In line with previous evidence [ 8 , 10 , 16 ], our study reports no cases of perioperative stroke, no cases of new-onset dialysis, and only two cases (0.64%) of perioperative MI. In our study, we present seven cases (2.3%) of newly manifested AF, which is favorable compared to previously reported rates [ 8 , 16 ]. We report no need for intraoperative blood transfusion in our cohort and a short duration of ICU (1.0, 0–1.0 days) and in-hospital stay (8.7 ± 5.5 days), which is comparable to previously published data [ 8 , 9 ] reporting a significantly lower proportion of transfused patients and a shorter ICU and in-hospital stay amongst MIDCAB patients [ 16 , 17 , 18 ].…”

“…The mean operation time in our cohort was 129.7 ± 35.3, which is lower than the previously reported data [ 8 , 9 ]. The present study reports comparable short-term results with respect to the literature with an in-hospital mortality of 0.64%, a 6-month mortality of 0.97%, and a 1-year mortality of 0.97%.…”

“…The present study reports comparable short-term results with respect to the literature with an in-hospital mortality of 0.64%, a 6-month mortality of 0.97%, and a 1-year mortality of 0.97%. The mean follow-up time in the present study was 16.3 ± 6.3 years, which was longer than most of the comparable studies [ 7 , 8 , 9 , 10 , 11 ]. Our results regarding the 10-year survival rate (94.3%) for the entire cohort are favorable compared to the existing evidence in the literature [ 7 , 12 , 13 , 14 ].…”

Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting

“…MIDCAB surgery has been proposed as a less invasive alternative to full sternotomy revascularization in isolated LAD disease or in the context of hybrid revascularization strategies. Several reports have described low perioperative morbidity and mortality and excellent long-term survival ( 15 – 17 ). In the largest single-center cohort of a total of 2,667 patients who underwent MIDCAB surgery over a 22-year period—the longest follow-up reported so far—Davierwala and colleagues from the Leipzig group recently reported survival estimates of 88.0, 77.7, 66.1 and 55.6% at 5, 10, 15 and 20 years, respectively, which impressively was found to be better than the age- and sex-adjusted German population.…”