MIDCAB CHARACTERISTICS AND RESULTS - THE CARDIOTHORACIC SYSTEMS (CTS)REGISTRY

Objective: The CardioThoracic Systems (CTS) registry of minimally inva sive direct coronary artery bypass (MIDCAB) was established to examine baseline characteristics of patients undergoing this surgical procedu re, document details of the procedures including grafting techniques a nd post-operative complication rates, and assess post-operative graft patency. Methods: A total of 508 consecutive patients who had MIDCAB u sing CTS instrumentation between April 1996 and March 1997 at 35 inter national centers were analyzed. Results: The mean age of patients, 27% of whom were women, was 63 years. Eight percent had previous coronary artery bypass surgery. While nearly all patients had significant sten oses in the left anterior descending artery, 23% had disease in two ve ssels and 9% in three vessels. Almost all procedures used the left int ernal mammary artery, with 7% employing multiple or sequential grafts. The entire surgical procedure lasted on average 135 min (median 2 h), with a mean time of 14 min to perform anastomosis. Surgical approache s, including anastomosis technique and method used to maintain bloodle ss field, varied widely across clinical centers. In-hospital complicat ion rates were relatively low, with 0.6% mortality (0% perioperative), 1.2% conversion to sternotomy with cardiopulmonary bypass, 1.4% conve rsion to sternotomy without bypass, and 5.5% redo or reintervention. I n total, 92% of patients were free from all of these events at hospita l discharge; women showed a strong trend toward increased risk for maj or in-hospital events compared with men. Rib fracture was the most com mon complication, reported in 12% of patients. Post-operative angiogra phy, performed in 83 patients at an average 2.2 days post-procedure, f ound full patency in 78 (94%). Conclusions: The CTS registry data indi cates that in the great majority of patients, MIDCAB using CTS instrum entation was performed safely and with acute success. Comparative stud ies, most importantly clinical trials, are needed to determine the typ es of patients who benefit most from this procedure, as well as its lo nger-term outcome. (C) 1998 Elsevier Science B.V.