Revascularization after minimally invasive coronary artery bypass grafting in 566 patients: Is it a problem?

Abstract

Minimally invasive coronary artery bypass grafting (MICS CABG) allows visualization and revascularization of all myocardial territories through a small anterolateral thoracotomy, with or without cardiopulmonary bypass. It is increasing in popularity as a safe and effective alternative to sternotomy CABG. In this study, we examined the correlates and long-term outcomes of repeat revascularization (RR) in patients who undergo MICS CABG. We prospectively followed all patients on an annual or semiannual basis who had undergone MICS CABG surgery over a 17-year period at a single institution. Cumulative incidence of RR was calculated accounting for competing risk of mortality. Kaplan-Meier curves were compared with log-rank test for survival and freedom from cardiac death at 12-years for both groups. Multivariable Cox proportional hazard models were performed to identify variables associated with RR and its impact on long-term survival. Clinical follow-up was complete for 100% of patients (N = 566) at a mean of 7.0 ± 4.4 years. Forty-nine (8.7%) patients required RR after their MICS CABG, for a cumulative incidence at 12 years of 14.8 ± 2.5%. The most common indication was progression of native coronary disease in 23 (46.9% of RR) patients. Perioperative transfusion was the only variable associated with RR (hazard ratio, 5.0; 95% confidence interval, 2.4-10.3). When we compared patients who had RR with those who did not, there was no significant difference in late survival (92.1 ± 4.5% vs 80.3 ± 3.0%; P = .18). Among 566 patients who underwent MICS CABG over a 17-year period, RR was an infrequent event affecting 8.7% of patients, with no negative impact on long-term survival.