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

Background. We reviewed the initial patient series of three institutions pe rforming large volume port-access (FA) coronary artery bypass grafting (CAB G) to evaluate the efficacy of this new procedure. Methods. From October 1996 until June 1998, 302 consecutive patients underw ent isolated CABG using the PA approach. Patients (mean age 60.7 years) wer e 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 distribut ion 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 T horacic Surgeons (STS) Database data collection form was used prospectively by all three institutions to define patient risk factors and record outcom es. Results. Total 30-day hospital mortality was 0.99% compared to the STS-data base-model-predicted risk of 1.2%. Complication rates for the PA CABG patie nts compared with risk-matched morbidity rates from the STS data for CABG a lone 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 perioperat ive 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 tradi tional CABG patients (confidence intervals not available). Likewise, the mo rbidity was low, with minimal ventilatory support, pulmonary complications, and atrial fibrillation. The port-access technique is an acceptable strate gy for multivessel bypass grafting. (C) 1999 by The Society of Thoracic Sur geons.