Clinical And CT angiographic Long-term Follow-up Of Totally Endoscopic Coronary Artery Bypass Grafting
Markus Kofler1, Lukas Stastny1, Julia Dumfarth1, Gudrun Feuchtner1, Guy Friedrich1, Thomas Schachner2, Johannes Bonatti3, Nikolaos Bonaros1.
1Medical University of Innsbruck, Innsbruck, Austria, 2Johannes Kepler University, Linz, Austria, 3Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
OBJECTIVE: Totally endoscopic coronary artery bypass grafting (TECAB) was shown to be feasible and safe, with excellent clinical and angiographic mid-term follow-up. The value of less invasive techniques of coronary revascularization regarding long-term clinical and angiographic outcome is still unknown. Therefore, we aimed to investigate long-term MACCE-rate and LIMA patency-rate in arrested heart TECAB patients. METHODS: From 2001 to 2012 a total of 208 arrested heart TECAB patients were included. 145 (69.7%) were isolated LIMA LAD TECAB’s. Mean age was 58.8 ± 9.4 years, mean logEuroSCORE 1.6 ± 1.5%. The combined clinical endpoint MACCE, defined as a composite of death, myocardial infarction, stroke, re-PCI, re-CABG and any form of target vessel revascularization, was used to evaluate long-term clinical outcome at a mean follow-up of 6.9 ± 2.3 years. Patency rate was assessed using ECG guided cardiac computed tomography. Graft patency was defined as grade A if completely patent, grade B if stenosis was less than 50% and grade 0 if stenosis was more than 50% or for total occlusions. Mean time period from surgery to CT was 6.9 ± 2.8 years.
RESULTS: Survival rate at 1, 5 and 10 years was 100%, 98.3% and 95.8%, respectively. Freedom from MACCE at 1, 5 and 10 years was 93.5%, 85.9% and 83.0%, respectively. At 1, 5 and 10 years freedom from myocardial infarction was 99.0%, 97.4% and 95.9%, freedom from target vessel revascularization 96.0%, 94.3% and 91.7%, percutaneous coronary intervention 94.5%, 91.6% and 84.2%, re-CABG 100%, 99.5% and 99.5%, respectively. Patency rate at 5 and 10 years was 94.9% and 88.1%, respectively. The main reason for long-term graft occlusion was collateral flow. No early graft occlusion due to technical problems was observed.
CONCLUSIONS: Arrested heart TECAB shows an excellent long-term clinical follow-up. LIMA patency rate for arrested heart TECAB is comparable to conventional CABG at 10 years after surgery.
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