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.