Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Outcome after minimally-invasive coronary artery bypass (MIDCAB) in patients with coronary multi-vessel disease 
C. Grothusen1, J. Arndt2, C. Borzikowsky2, K. Huenges2, H. Möllmann1, A. Haneya2, B. Panholzer2, J. Cremer3
1Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund; 2Universitätsklinikum Schleswig-Holstein, Kiel; 3Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Kiel;

Background: Patients with complex coronary artery disease (CAD) benefit from surgical myocardial revascularization but are at increased risk for peri-operative complications. Minimally-invasive coronary artery bypass (MIDCAB) procedures are less invasive, provide the prognostic benefit of operative revascularization of the left anterior descending artery (LAD) and may be part of hybrid procedures. 


Methods: Between 1998 and 2018, 1363 patients underwent MIDCAB. Data of  patients with coronary 1-vessel disease (VD) compared to patients with 2, and 3-VD(referred to as multi-VD(MVD)) were analysed.


Results: Patients with MVD were significantly older (66.15 ±10.98 vs 62.96 ±11.21 years; p<0.001), suffered more often from severly reduced left ventricular function (n=9 (1.4%) vs n=30 (4.1%);p=0.003), previous myocardial infarction (n=177 (28.2%)     vs n=302 (41.1%); p<0.001) and prior cardiac surgery (n=10 (1.6%) vs n=56 (7.6%);p<0.001) resulting in a higher EuroScore II (1.24 {0.35; 12.05} vs       2.10 {0.35; 34.15};p<0.001). Left main stenosis was more often present in patients with 2, and 3-VD (n=2 (0.3%) vs n=188 (25.6%);p<0.001). Prior PCI had more often been performed in this group (n=167 (26.6%) vs n= 311 (42.4%);p<0.001). Patients with MVD had a significantly higher stroke rate (n=4 (0.6%) vs n=17 (2.3%);p=0.014). 30-day mortality was not significantly different but long-term survival was significantly lower in patients with MVD. Hybrid procedures had been planned in n=299 (22.7%) patients and were realized in n=183 (65.1%). One-year survival rates between patients, in which a hybrid procedure was realized compared to those, where this procedure had not been performed, were similar (p=0.32). However, long-term survival analysis revealed that patients with complete hybrid procedures had an improved survival compared to those with incomplete revascularization. The main reason for not completing hybrid procedures was lack of symptoms indicating ischemia. 


Conclusion: MVD patients with complex CAD are at an increased risk for cardiovascular death and peri-interventional complications. If completed, hybrid procedures may result in a survival benefit. 
https://dgk.org/kongress_programme/jt2022/aP2036.html