Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) for Chronic Total Occlusion of the Left Anterior Descending Artery

Background: Coronary bypass grafting (CABG) is often the last option to treat chronic total occlusions (CTO) of the left anterior ascending artery (LAD). Minimally invasive CABG (MIDCAB) is a sternotomy-sparing approach to graft-isolated LAD lesions. We assessed our MIDCAB experience in patients with CTO of LAD.

Method: We retrospectively analyzed data of all patients (n = 100) who underwent MIDCAB due to CTO of the LAD between January 2007 and December 2021 in our center. Data are presented as a median (interquartile range, 25–75th percentile) or frequencies (%). Follow-up was complete in 100%. Mean follow-up time was 65 (19–105) months. Quality of life was assessed using European Quality of Life 5-Dimensions 3-Level Version questionnaires.

Results: Most patients were male (81), with a median age of 62 (57–69), and an intermediate surgical risk EuroSCORE II 3.0 (1.25–5.0). MIDCAB procedural time was 119 (99–151) minutes. No conversion to sternotomy was needed. Grafting of the LAD succeeded in 98%, and in one patient, the diagonal branch was connected instead of the calcified LAD. Nine patients (9%) were reexplored for bleeding. Postoperative myocardial infarction occurred in one patient. No patient experienced a postoperative stroke. Mortality at 30 days was 1% which represents a third of the expected mortality. 10-year survival was 88%. Quality of life was comparable to the normal German population.

Conclusion: Our results suggest that MIDCAB is a safe and valuable option to treat CTO of the LAD. Perioperative risk is low, long-term results are good, and the quality of life is equal to the normal German population.

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Artikel online veröffentlicht:
28. Januar 2023