Results
In total, 186 patients successfully underwent elective MICS CABG. The mean number of grafts per patient was 2.81 (range, 2–5). Overall, 522 grafts were constructed. No patient required conversion to sternotomy or extracorporeal circulation support intraoperatively. Three of 186 (1.6%) patients required intraoperative support by an intra-aortic balloon pump (IABP) because of ischemia, arrhythmia, or hemodynamic instability. Postoperatively, eight (4.3%) patients underwent re-exploration. Additionally, three (1.6) patients underwent insertion of an IABP for postoperative hemodynamic support. The postoperative mortality rate was 1.6% (3/186). The cause of death was postoperative myocardial infarction in two patients and stroke in one patient. The postoperative variables are listed in Table 3.
A total of 181 patients underwent postoperative angiography before discharge. The reasons why the remaining five patients did not undergo angiography are listed in Table 4. The postoperative graft angiography showed that the overall patency rate was 96.3% (491/510). Further analysis of graft patency showed that the patency rate of the LITA was 98.3% (171/174), that of the SV was 95.2% (318/334), and that of the RA was 100% (2/2). The subgroup analysis results of the graft patency rate in the three different systems of the coronary artery and/or its branches are shown in Table 5.
A total of 96.8% (180/186) of patients achieved complete coronary revascularization. One of the six patients with ICR developed postoperative bradycardia and hypotension. This patient underwent emergency invasive angiography with the support of an IABP and recovered after treatment of a tight stenosis at the orifice of the RCA with a drug-eluting stent. The CR rate was 97.3% (181/186) after complementary PCI. The main cause of ICR was underestimation of stenosis on the preoperative angiogram.
Calculated by graft, the revascularization rate was 98.9% (522/528) before and 99.1% (523/528) after complementary PCI.
In total, 179 of 183 (97.8%) patients were closely followed up for a mean of 18 ± 10.2 months (range, 4–41 months). During follow-up, one patient experienced sudden death and another died of stomach cancer at 1 and 36 months after discharge, respectively. Five of 183 (2.7%) patients developed postoperative major adverse cardiovascular and cerebral events (4 strokes and 1 repeat PCI for native coronary artery restenosis). Finally, 182 of 183 (99.5%) patients survived without symptoms of myocardial ischemia.