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

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.