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Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin

^a Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University of Singapore, 5 Lower Kent Ridge Road, Level 2, 119074 Singapore
^b Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^c Department of Internal Medicine/Cardiology, University of Leipzig – Heart Centre Leipzig, Germany
^d Division of Cardiothoracic Surgery, Democritus University Medical School, Alexandroupolis, Greece

*Corresponding author. Tel.: +65 6772 2065; fax: +65 6776 6475.

E-mail address: surtk{at}nus.edu.sg (T. Kofidis).

In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30±11.2 months, 390 patients were assessed with Wald test-corrected ² analysis to identify preoperative factors which correlate with a higher incidence of post-MIDCABG MI, PCI, CABG and mortality from cardiac causes. We found an increased incidence of postoperative MI in patients with 2-vessel (8.7%) and 3-vessel (7.7%) vs. 1.3% 1-vessel coronary artery disease (CAD) (P=0.023), and in patients with preceding cardiac procedure (CABG and PCI: 8.4% vs. 2.0% without, P=0.023). Also diabetes was associated with higher post-MIDCABG frequency of MI (P=0.035). Severity of angina was associated with lesser post-MIDCAB-PCI (P=0.011) while preceding CABG predicted a higher incidence (P=0.012). Preoperative low ejection fraction (EF) (multivariate, P<0.001), preoperative MI (P=0.007) and extent of CAD (P=0.001) were associated with a higher post-MIDCABG mortality. None of the parameters correlated with subsequent CABG MIDCABG. The extent and history of CAD, history of cardiac interventions and low EF seem to influence the outcome adversely and should be considered deciding pro or against the MIDCAB-option.

Key Words: Coronary disease; Procedures; Minimally invasive surgical; Predictive factors; Follow-up