Early and long-term results of minimally invasive coronary artery bypass grafting in elderly patients.
Background: Standard (conventional) coronary artery bypass grafting (CABG) is an invasive procedure which requires full
median sternotomy and is performed with extracorporeal circulation (ECC), which can lead to serious complications. Aim: To analyse the results of minimally invasive CABG (MIDCAB) in elderly patients.
 Methods: Between 1999 and 2007, a total of 698 MIDCAB procedures were performed at our institution. We present the
data on 235 elderly (≥ 70 years) patients (160 males, mean age 74.5 ± 3.2 years, range: 70-83 years) who were consecutively
operated on in this period. Early mortality, post-operative complications, long-term survival, impact of multivessel disease
(MVD) and hybrid coronary artery revascularisation on total mortality were analysed. Logistic EuroSCORE was 8.7%. The
survival of 235 elderly patients was compared to the survival of the remaining 463 MIDCAB patients aged Results: The 30-day mortality was 2.5% (six patients). During follow-up, two patients underwent coronary reoperation and
percutaneous coronary intervention (PCI) was performed in 16 patients. Kaplan-Meier analysis revealed a 1.5-year survival of
89.8% (95% CI 85.9-93.7%) and five-year survival of 79.7% (95% CI 74.3-85%). Compared to single vessel disease (SVD)
patients, the MVD patients had significantly higher total mortality (p = 0.0038). Our study revealed MVD (p = 0.0016) and
male sex (p = 0.0091) as important independent factors of total mortality in this group of elderly patients. The difference in
total mortality between non-hybrid vs hybrid MIDCABs was not significant (p = 0.63). The younger MIDCAB patients ( Conclusions: The MIDCAB is a reasonable option for elderly patients with SVD, and in selected patients with MVD. The
decision to perform MIDCAB rather than PCI in these high risk patients should always be very carefully considered in conjunction
with the interventional cardiologist.
 Kardiol Pol 2011; 69, 3: 213-218