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Ann Thorac Surg 1999;68:1475-1477
© 1999 The Society of Thoracic Surgeons

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Supplement: Minimally Invasive Cardiac Surgery

Results of a prospective multicenter study on port-access coronary bypass grafting

^a New York University School of Medicine, New York, New York, USA
^b Memorial Mission Hospital, Asheville, North Carolina, USA
^c Fairfax Hospital, Falls Church, Virginia USA

Address reprint requests to Dr Grossi, New York University Medical Center, Suite 9-V, 530 First Ave, New York, NY 10028
e-mail: grossi{at}cv.med.nyu.edu

Presented at Evolving Techniques and Technologies in Minimally Invasive Cardiac Surgery, San Antonio, TX, Jan 22–23, 1999.

Abstract

Background. We reviewed the initial patient series of three institutions performing large volume port-access (PA) coronary artery bypass grafting (CABG) to evaluate the efficacy of this new procedure.

Methods. From October 1996 until June 1998, 302 consecutive patients underwent isolated CABG using the PA approach. Patients (mean age 60.7 years) were predominantly male (77.5%) and received a mean of 2.3 distal anastomoses; few were New York Heart Association class III or IV (15.9%). The distribution of the number of grafts was: 76 (25.2%) single, 110 (36.4%) double, 73 (24.2%) triple, and 43 (14.2%) four or more bypass grafts. The Society of Thoracic Surgeons (STS) Database data collection form was used prospectively by all three institutions to define patient risk factors and record outcomes.

Results. Total 30-day hospital mortality was 0.99% compared to the STS-database-model-predicted risk of 1.2%. Complication rates for the PA CABG patients compared with risk-matched morbidity rates from the STS data for CABG alone were: reoperation for bleeding, 3.3% versus 1.9%; ventilatory support more than 1 day, 1.7% versus 3.8%; stroke, 1.7% versus 1.2%; and perioperative transmural myocardial infarction 0% versus 1.3%.

Conclusions. The STS CABG risk-adjusted model demonstrates that the 30-day mortality for patients undergoing PA CABG is lower than predicted for traditional CABG patients (confidence intervals not available). Likewise, the morbidity was low, with minimal ventilatory support, pulmonary complications, and atrial fibrillation. The port-access technique is an acceptable strategy for multivessel bypass grafting.

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