Davierwala Piroze M, Verevkin Alexander, Bergien Laura, von Aspern Konstantin, Deo Salil V, Misfeld Martin, Holzhey David, Borger Michael A
Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany.
Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany.
J Thorac Cardiovasc Surg. 2023 Jan;165(1):115-127.e4. doi: 10.1016/j.jtcvs.2020.12.149. Epub 2021 Feb 17.
Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality.
A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods.
The mean age was 64.5 ± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I = 4.9 ± 6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I = 3.1 ± 4.5) and B (log EuroSCORE I = 3.5 ± 4.7). Overall and groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .7), respectively. Overall 10-, 15-, and 20-year survival estimates for all patients were 77.7 ± 0.9%, 66.1 ± 1.2%, and 55.6 ± 1.6%, respectively.
MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.
在一些特定中心，对于孤立性复杂左前降支冠状动脉疾病患者，常规通过左前小切口开胸进行微创直接冠状动脉旁路移植术（MIDCAB），即使用左乳内动脉进行左前降支冠状动脉移植，但文献中关于长期预后的报道很少。我们的研究旨在评估和分析一大群接受MIDCAB手术患者的早期和长期预后，并确定患者特征变化趋势对早期死亡率的影响。
将1996年至2018年间接受MIDCAB手术的2667例患者，根据手术年份分为3组：A组，1996 - 2003年（n = 1333）；B组，2004 - 2010年（n = 627）；C组，2011 - 2018年（n = 707）。比较各组特征和术后早期预后。分析所有患者的长期生存率，并使用Cox比例风险方法确定晚期死亡率的预测因素。
平均年龄为64.5±10.9岁，691例（25.9%）患者为女性。C组患者（欧洲心脏手术风险评估系统I评分对数=4.9±6.9）比A组（欧洲心脏手术风险评估系统I评分对数=3.1±4.5）和B组（欧洲心脏手术风险评估系统I评分对数=3.5±4.7）年龄更大，有更多的心脏危险因素和合并症。总体及各组的住院死亡率分别为0.9%、1.0%、0.6%和1.0%（P = 0.7）。所有患者的总体10年、15年和20年生存率估计分别为77.7±0.9%、66.1±1.2%和55.6±1.6%。
MIDCAB手术可以安全地进行，早期和长期预后良好。尽管患者的人口统计学特征恶化，但在该研究的22年期间，住院死亡率保持不变。
