How to BYPASS to a better quality of life: Determining and improving clinical and patient-centred outcomes after totally endoscopic cardiac surgery

Abstract

Introduction Totally endoscopic coronary artery bypass grafting (TECAB) is a minimally invasive approach to achieve surgical revascularisation through a minimally invasive approach. Still, data regarding non-robotic TECAB is limited. This report presents the results of a TECAB technique using long-shafted instruments, defined as Endo-CABG, from a single-centre experience in 1500 consecutive patients. Methods A total of 1500 patients underwent Endo-CABG between January 2016 and February 2023. Data were collected retrospectively, and patients were followed up for one year. The primary outcome of this study was major adverse cardiac and cerebrovascular events (MACCE)-free survival. Secondary efficacy outcomes were graft failure and mortality. Furthermore, we analysed factors influencing long-term freedom from MACCE and all-cause mortality. Results The mean age was 68 [61-75] years, of which 193 (12.87%) were octogenarians. Multivessel disease was present in 1409 (93.93%) patients, and the mean EuroSCORE II was 1.64% [1.09-2.92]. All patients underwent complete arterial revascularisation with bilateral internal mammary grafting in 88.47%. Graft failure occurred in 1.80% of cases after one year (n=27). Thirty-day mortality was 1.73% (n=26), one-year survival was 94.7% (95%CI:93.5-95.9%), and 1-year MACCE-free survival was 91.7% (95%CI:90.2-93.2%). Younger age, good left ventricular ejection fraction, absence of arterial hypertension, and absence of urgent surgery were significantly associated with 1-year MACCE-free survival. Conclusions Endo-CABG appears to be a safe procedure, achieves surgical revascularisation, and provides good outcomes regarding graft failure and major adverse cardiac and cerebrovascular events at one year, while age, left ventricular ejection fraction, arterial hypertension, and urgency were associated with one-year outcomes.