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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2011

Open Access 01-12-2011 | Research article

Is there an optimal minimally invasive technique for left anterior descending coronary artery bypass?

Authors: Olivier Jegaden, Fabrice Wautot, Thomas Sassard, Isabella Szymanik, Abdel Shafy, Joel Lapeze, Fadi Farhat

Published in: Journal of Cardiothoracic Surgery | Issue 1/2011

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Abstract

Background

The aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB).

Methods

Over a decade, 160 eligible patients for elective LAD bypass were referred to one of the three techniques: 48 PA-CABG, 53 MIDCAB and 59 TECAB. In MIDCAB group, Euroscore was higher and target vessel quality was worse. In TECAB group, early patency was systematically evaluated using coronary CT scan. During follow-up (mean 2.7 ± 0.1 years, cumulated 438 years) symptom-based angiography was performed.

Results

There was no conversion from off-pump to on-pump procedure or to sternotomy approach. In TECAB group, there was one hospital cardiac death (1.7%), reoperation for bleeding was higher (8.5% vs 3.7% in MIDCAB and 2% in PA-CABG) and 3-month LAD reintervention was significantly higher (10% vs 1.8% in MIDCAB and 0% in PA-CABG). There was no difference between MIDCAB and PA-CABG groups. During follow-up, symptom-based angiography (n = 12) demonstrated a good patency of LAD bypass in all groups and 4 patients underwent a no LAD reintervention. At 3 years, there was no difference in survival; 3-year angina-free survival and reintervention-free survival were significantly lower in TECAB group (TECAB, 85 ± 12%, 88 ± 8%; MIDCAB, 100%, 98 ± 5%; PA-CABG, 94 ± 8%, 100%; respectively).

Conclusions

Our study confirmed that minimally invasive LAD grafting was safe and effective. TECAB is associated with a higher rate of early bypass failure and reintervention. MIDCAB is still the most reliable surgical technique for isolated LAD grafting and the least cost effective.
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Metadata
Title
Is there an optimal minimally invasive technique for left anterior descending coronary artery bypass?
Authors
Olivier Jegaden
Fabrice Wautot
Thomas Sassard
Isabella Szymanik
Abdel Shafy
Joel Lapeze
Fadi Farhat
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2011
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-6-37

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