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Results after MIDCAB and OPCAB surgeries: problems and consequences of incomplete angiographic follow-up in the mid-term course

^a Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
^b Department of Cardiology, University Hospital Freiburg, Freiburg, Germany

^* Corresponding author. Tel.: +49-761-270-2881; fax: +49-761-270-2368
weigang{at}ch11.ukl.uni-freiburg.de

OBJECTIVE: The aim of this study was to evaluate the mid-term course of all patients who had undergone minimally invasive coronary artery bypass grafting in our department between January 1996 and September 2001. The procedures were performed on the beating heart without the use of cardiopulmonary bypass. Either median sternotomy (60 patients) or anterolateral thoracotomy (29 patients) was used for access. Evaluation focused on perioperative complications, quality of life, clinical status, graft patency, survival and freedom from cardiac events. Special emphasis was put on the problems and consequences of incomplete angiographic follow-up.

METHODS: Survival and postoperative cardiac events of all patients were evaluated. All surviving patients were invited for follow-up examination. Angiographic control was recommended to all patients.

RESULTS: Survival after 30 days was 100%. Two patients (2%) suffered from perioperative myocardial infarction due to early graft failure, which required reoperation in standard technique in both cases. Mean follow-up period was 25 months. Mean NYHA class improved from preoperative 2.3 to current 1.6, and the mean CCS class from 2.1 to 0.8. Angiographic controls were performed in 46/89 patients. Fifty-three anastomoses were evaluated, 47 of which showed no occlusion (patency rate 89%). Forty-two anastomoses (79%) were free of significant stenosis. In 27 patients without symptoms we recommended angiography for control purposes and observed a patency rate of 97%. Nineteen patients had already undergone angiographic control due to clinical complaints prior to follow-up examination. That group's graft patency rate was 78%. Survival was 98% after 1 year and 94% after 3 years. Survival free of cardiac events (myocardial infarction, reoperation, percutaneous transluminal coronary angioplasty) was 86% in the first year and 80% after 3 years.

CONCLUSIONS: The results concerning survival, freedom from events, and clinical status are encouraging. It was not possible to perform angiographic controls in all patients since some of them and their primary physicians could not be convinced of the necessity of this control in the absence of clinical complaints. This explains the negative bias in our results.

Key Words: Coronary artery bypass; Surgical procedures; Minimally invasive; Treatment outcome; Follow-up studies; Coronary angiography; Quality of life