title: Mid-Term Outcomes of Minimally Invasive Direct Coronary Artery Bypass Grafting.
abstract: BACKGROUND
  Minimally invasive direct coronary artery bypass grafting (MIDCAB) has gained wide acceptance for the treatment of single vessel disease of the left anterior descending artery (LAD). Here, we present our single center experience of 152 consecutive patients.
  
  
  METHODS
  All patients underwent MIDCAB through a left anterior minithoracotomy between January 1, 2009, and December 31, 2012. Preoperative, intraoperative, postoperative, and follow-up data including major adverse cardiac and cerebrovascular events (MACCE) and need for re-intervention were collected.
  
  
  RESULTS
  Mean age was 64.4 ± 11 years, median additive EuroSCORE 3 (0-11), 84% were male. All except one patient were successfully operated without cardiopulmonary bypass. Seven patients with unexpected severely calcified LADs were converted to sternotomy (4.6%); 91.3% were extubated in the operating room or on the day of surgery. Median stay at the intensive care unit and in hospital were 1 (0-97) and 7 (1-49) days, respectively. Thirty-day mortality was 1.9%. There was no stroke. Five patients (3.2%) had to be re-explored for bleeding and 95% received no transfusion. Median follow-up was 24 months (0-97) and complete in 93.3% with overall survival of 92.4 ± 0.2% and MACCE-free survival of 96.1 ± 1.7%. Two patients had a re-intervention of the LAD.
  
  
  CONCLUSIONS
  MIDCAB is a safe procedure with low postoperative morbidity, mortality, and favorable mid-term MACCE-free survival in selected patients that should be discussed in a heart team setting to evaluate the "ideal" individual treatment option.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Diana
authors.initials: D
authors.lastname: Reser
authors.affiliation: University of Zurich, Zurich, Switzerland.
authors.forename: Mathias van
authors.initials: Mv
authors.lastname: Hemelrijck
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jovana
authors.initials: J
authors.lastname: Pavicevic
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Herman
authors.initials: H
authors.lastname: Tolboom
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tomas
authors.initials: T
authors.lastname: Holubec
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome