One-year clinical outcome after minimally invasive direct coronary artery bypass

Background-Minimally invasive coronary artery bypass (MIDCAB) is a new surg ical technique by which the left internal mammary artery is anastomosed und er direct visualization to the left anterior descending artery without card iopulmonary bypass. Methods and Results-We followed all 274 patients who underwent MIDCAB from the time it was introduced at a single center. In-hospital and 1-year clini cal events were source-documented and adjudicated. The in-hospital major ac ute cardiac event rate was 2.2%; this included a 1.1% mortality rate. At 1 year, the respective rates were 7.8% and 2.5%. When compared with the initi al 100 procedures, the subsequent 174 procedures had shorter vessel occlusi on times (10+/-5 versus 14+/-6 minutes; P=0.009), times to extubation (6+/- 3 versus 14+/-10 hours; P<0.001), and lengths of hospital stay (2.1+/-1.9 v ersus 3.2+/-3.1 days; P=0.04). Cumulative 1-year adverse cardiac events wer e 11% in the initial 100 cases and 6% in the subsequent 174 cases (P=0.17). Conclusions-Excellent clinical results can be achieved with the MIDCAB tech nique. The clinical adverse event rate may decrease with accumulated experi ence.