Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery

OBJECTIVE Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal...

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Published in:Swiss medical weekly Vol. 147; no. 2728; p. w14474
Main Authors: Winkler, Bernhard, Heinisch, Paul Philipp, Zuk, Grzegorz, Zuk, Katarzyna, Gahl, Brigitta, Jenni, Hans Jörg, Kadner, Alexander, Huber, Christoph, Carrel, Thierry
Format: Journal Article
Language:English
Published: Switzerland SMW supporting association (Trägerverein Swiss Medical Weekly SMW) 10.07.2017
Subjects:
Aged
artery
bypass
circulation
Cohort Studies
coronary
Coronary Artery Bypass - methods
Coronary Artery Bypass - mortality
coronary artery bypass grafting
Coronary Artery Disease - mortality
Coronary Artery Disease - surgery
expectancy
Extracorporeal Circulation - methods
Extracorporeal Circulation - mortality
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Life Expectancy
Male
Middle Aged
Postoperative Complications - etiology
Postoperative Complications - mortality
Postoperative Period
Treatment Outcome
ISSN:1424-3997, 1424-3997
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Summary:OBJECTIVE Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal circulation. This study presents early and long-term outcomes after CABG with use of MiECC in a single-centre consecutive patient cohort. METHODS From 1 January 2005 to 31 December 2010, 2130 patients underwent isolated CABG with MiECC at our centre. We evaluated morbidity and mortality follow-up data with a median follow-up of 3.6 years. Kaplan-Meier curves and estimates of the primary end-point for all-cause mortality were compared with the life expectancy of the general population. RESULTS Mortality in CABG patients was comparable to the general population beginning 1 year after surgery for the whole observation period. All-cause 30-day mortality was 0.8%. The mean estimated logistic EuroSCORE and EuroSCORE II were 5.8 ± 8.6 and 3.0 ± 5.1, respectively. Mean perfusion time was 71.1 ± 23.8 min with a cross-clamp time of 44.9 ± 16.3 min. Mortality was predicted by the presence of diabetes mellitus (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40–2.46; p <0.001), peripheral arterial disease (OR 2.36, 95% CI 1.64–3.38; p <0.001), severe obstructive pulmonary disease (OR 3.21, 1.42–7.24; p = 0.005), chronic renal failure (OR 3.68, 2.49–5.43; p <0.001) and transfusion of more than one unit of erythrocyte concentrate in the perioperative period (OR 1.46, 1.09–1.95; p = 0.015). Cerebrovascular events occurred in 36 patients (1.7%). CONCLUSION CABG with use of MiECC is associated with a mortality rate comparable to the overall life expectancy of the general population. MiECC is the first choice for routine and emergency CABG at our centre with a 30-day mortality rate of 0.8% and a low complication rate.
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ISSN:1424-3997
1424-3997
DOI:10.4414/smw.2017.14474