ORIGINAL ARTICLE  CARDIAC SECTION Open access

The Journal of Cardiovascular Surgery 2023 October;64(5):534-40

DOI: 10.23736/S0021-9509.23.12621-8

Copyright © 2023 THE AUTHORS

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language: English

Minimally invasive strategies of surgical coronary artery revascularization for the aging population

Magdalena I. RUFA ¹ ✉, Adrian URSULESCU ¹, Dincer AKTUERK ², Ragi NAGIB ¹, Marc ALBERT ¹, Nora GÖBEL ¹, Tunjay SHAVAHATLI ¹, Ulrich F. FRANKE ¹

¹ Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany; ² Barts Heart Center, Barts Health NHS, London, UK

BACKGROUND: The increasing prevalence of elderly or frail patients with severe coronary disease, who are not suitable for interventional coronary revascularization, necessitates the exploration of alternative treatment options. A less invasive approach, such as minimally-invasive off-pump coronary-artery-bypass (MICS-CABG) grafting through mini-thoracotomy, which avoids both extracorporeal circulation and sternotomy, may be more appropriate for this patient population. This study, a retrospective, monocentric analysis, aimed to evaluate the long-term outcomes of these patients.
METHODS: The study included 172 patients aged 80 years or older, who underwent MICS-CABG between 2007 and 2018. The patients underwent single, double, or triple-vessel revascularization using the left internal thoracic artery, and in some cases, the radial artery or saphenous vein. Follow-up, mean duration of 50.4±30.8 months, was available for 163 patients (94.7%).
RESULTS: The mean age of the patients was 83.2±3.0 years, 77.3% of them were male. The EuroSCORE I additive was 11.0±12.1. There were no conversions to sternotomy or cardiopulmonary-bypass. The postoperative 30-day mortality rate was 2.9%, with 5 deaths. The in-hospital rate of major adverse cardiac and cerebrovascular events was 4.7% (perioperative myocardial infarction 1.2%, perioperative stroke 2.3%, repeat revascularization 1.2%). Acute renal kidney injury, (stage 3 KDOQI or more), occurred in 5 patients (2.9%) and new-onset atrial fibrillation in 6 patients (3.5%). The 1-, 3-, 5- and 8-year actuarial survival rate of the 30-day survivors was 97%, 82%, 73%, and 42%, respectively.
CONCLUSIONS: MICS-CABG grafting is associated with excellent early and long-term outcomes in eligible octogenarians.

KEY WORDS: Octogenarians; Coronary artery disease; Coronary artery bypass; Minimally invasive surgical procedures