Redo minimally invasive direct coronary artery bypass

Objectives: Conventional redo coronary artery bypass grafting is assosiated with an increased risk of mortality and morbidity due to manipulation of patent grafts, mediastinitis and the presence of pericardial adhesions. Minimally invasive direct coronary artery bypass (MIDCAB) may be an alternitive approach in selected patients.

Material and Methods: From January 1997 to October 2003 46 patients (mean age 66±7.4 years) out of a total of 1410 MIDCAB procedures who had undergone previous CABG or valve surgery using a standard sternotomy approach, were reoperated through a left lateral minithoracotomy using the LITA to the LAD. Predicted mortality was 13.6% (2.4%–72.8%) as calculated by the logistic Euroscore (ES), ejection fraction was 53.1% (14%–81%). Surgical results were analysed for mortality, morbidity, operation time hospital stay and event free survival.

Results: Mean operating time was 103±34min. There were two in-hospital deaths (4.6%). One because of malignant ventricular arrhythmia (ES: 60.9%), one because of GI beeding (ES: 29.2%). One patient had to be reoperated (2.3%). Patients were discharged after 9.4±2.6 days. There were no strokes and no myocardial infarction. Follow-up was completed in 92.1%. During the follow-up period of 37±21 month one patient developed angina and six patients died. The actuarial four year survival is 74.8% [95% CI: 51%–92%] and the actuarial four year event free-survival including freedom from angina, MACE (non cardiac death excluded) and reintervention is 81% [95% CI: 54%–97%].

Conclusions: MIDCAB can be considered as an alternative approach for redo coronary artery bypass grafting in selected patients.