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

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely per-formed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term out-comes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB pro-cedures 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 on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise 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 groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .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. Conclusions: 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. (J Thorac Cardiovasc Surg 2023;165:115-27)