Minimally invasive direct coronary artery bypass- reducing mortality in the elderly?

Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) is a valuable option in coronary artery surgery allowing for a gentle revascularization in the elderly. This concept including hybrid revascularization strategies may reduce early mortality in cardiac surgical patients.

Methods: From our collective comprising more than 600 MIDCAB patients we analyzed the data of 180 consecutive patients ≥70 years (100 male, 80 female, 70–89 years).

Results: Single vessel disease was only present in 57.8% of the patients, unstable angina was present in 25.6% of the patients, 11.2% had previous cardiac surgery, and 27.2% had previous PCI. A hybrid procedure (MIDCAB combined with subsequent PCI) was performed in 22 (12.2%) of the patients. Rethoracotomy was necessary in 2 patients (1.1%). 75.4% were extubated at the end of operation and 42.2% were transferred to regular ward on the same day. According to Euro SCORE criteria 51.1% of the MIDCAB patients (92 patients) were in a high risk group: Euro SCORE 6 plus with a 95% confidence limit for predicted early mortality of 10.93–11. The 30-day mortality of the 92 patients was 3.3%. The overall 30-day mortality was 2.8% in the MIDCAB group, compared to a 30-day mortality of 3.8% in conventional coronary artery bypass patients ≥70 years operated during the same time period.

Conclusion: MIDCAB is a valuable therapeutic alternative in patients with advanced age with a significant reduction of mortality in cardiac surgery.