Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis

Background: To perform a retrospective analysis of patients who underwent endoscopic atraumaticcoronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years.Methods: Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998–2002 (group 1), 2003–2005 (group 2), 2006–2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted.Results: The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99%of all patients. No mortality was observed up to 30 days. Complications in the early period includedpleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and woundinfection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%)patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency ofmajor adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR:3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63)influenced the incidence rate.Conclusions: The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The eliminationof cardiopulmonary bypass significantly reduces the number of complications