Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience.

Abstract Objective Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery (LAD) grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex LAD disease, but very few reports regarding long-term outcomes exist in literature. Our study aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients undergoing MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality. Methods A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups based on the year of surgery: Group A- 1996-2003 (n=1333); Group B- 2004-2010 (n=627) and Group C- 2011-2018 (n=707). Group-wise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods. Results The mean age was 64.5± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I=4.9±6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I=3.1±4.5) and B (log EuroSCORE I=3.5±4.7). Overall and group-wise in-hospital mortality was 0.9%, 1.0%, 0.6% and 1.0% (P=0.7), respectively. Overall 10-, 15- and 20-year survival estimates for all patients were 77.7±0.9%, 66.1±1.2% and 55.6±1.6%, respectively. Conclusion MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.