Long-term outcomes of off-pump minimally invasive coronary artery bypass grafting of the left anterior descending artery

Aim. To evaluate the long-term results of off-pump minimally invasive direct coronary artery bypass grafting (MIDCAB) of the left anterior descending artery (LAD). Methods. From 2011 to 2017, 146 patients with stable coronary artery disease and hemodynamically significant LAD disease who underwent minimally invasive coronary artery bypass grafting of the left internal mammary artery (LIMA) to the LAD were enrolled in this single-centre prospective study. Patients with significant stenosis of the left main coronary artery and those referred to a concomitant cardiac surgery were excluded. Of the 146 patients, 31 (19.8%) were lost to follow up. The average follow-up duration was 31.4 ± 20.9 mon. The study endpoints included death, myocardial infarction (MI), stroke, repeated myocardial revascularisation, and delayed wound healing. Results. The rate of fatal outcomes within the follow-up period was 6% (n = 7). The MI incidence rate was 2.6% (n = 3). Of the three MIs, one was fatal. Stroke was registered in 6% (n = 7) of the patients. In one case, the stroke was fatal; 1.2% (n = 2) of the patients required repeat PCI with stenting. The length of stay in the intensive care unit following the index surgery was 1.0 ± 0.2 d. Total 108 (73.9%) patients were discharged within 10 d. There were no complications of delayed wound healing. Conclusion. Thus, an analysis of the long-term treatment results (31.4 ± 20.9 months) showed satisfactory outcomes in patients with isolated LAD and multivascular coronary atherosclerosis, comparable to the results of standard coronary artery bypass grafting techniques. The survival rate of the patients was 94%, which, combined with the absence of wound complications in the hospital and the long-term follow-up period, provides evidence in favour of more active use of the MIDCAB technology as a popular option that allows successful revascularisation of the myocardium with minimally invasive access and off-pump technologies.