Very long-term outcome of Minimally Invasive Direct Coronary Artery Bypass

Background: Minimally invasive direct coronary artery bypass (MIDCAB) is a well-established low-impact surgical procedure for revascularization of left descending coronary artery with the left internal mammary artery. This work aims to evaluate safety, overall survival and freedom from major adverse cardio-cerebral events (MACCE) after 20 years of MIDCAB. Methods: We retrospectively collected a series of 141 patients who underwent MIDCAB between 1997 and 2017 to assess long-term outcome. Therefore, we analysed 133 patients who consequently underwent revascularization of left descending coronary artery with left mammary artery via a full median sternotomy. Results: Actuarial survival rate at Kaplan-Meier curve was 100%, 95%, 90%, 83% and 70% at 1, 5, 10, 15 and 20 years, respectively. Freedom from MACCE, defined as myocardial infarction, stroke and cardiac death, was 97%, 90%, 79%, 75% and 61% at 1,5,10,15 and 20 years, respectively. At Cox multivariable analysis, age, cancer and chronic renal insufficiency have been found to be independent predictors affecting long-term survival, with a hazard ratio of 1,12 (p 0.007), 17,63 (p<0.001) and 5.16 (p 0.03), respectively. MIDCAB group showed a significantly lower rate of in-hospital stay, blood transfusions, cardiac-related and all-causes events compared to full sternotomy group (p=0,02 and p=0,0001, respectively). Conclusions: Very long-term clinical outcome of MIDCAB is satisfactory in terms of survival and freedom from MACCE. MIDCAB significantly reduces in-hospital stay and blood transfusions when compared to full sternotomy bypass surgery on left descending coronary artery and appears to effectively improve prognosis in terms of cardiac- and all-causes events.