Minimally Invasive OPCAB using Subclavian Artery Inflow

Doosang Kim

VHSMC, Seoul, KOREA

 

BACKGROUND: In terms of inflow feeder to coronary target, internal thoracic artery and aorta are frequently used worldwide. We have been tried subclavian artery as inflow when redo CABG or even first time CABG in elderly and frailties. Here we report the mid-term results of this approach of minimally invasive OPCAB as single institute experiences.

METHODS: From April 1998 to January 2025, among the 984 CABG patients, we conducted MICS OPCAB in 147 patients (15%) since 2000, and MICS OPCAB using subclavian artery inflow in 64 (7%) patients since 2016 and these are subjects. Median age was 74 (IQR 71-75) years old and most of them were male (95%, 61 patients). Among them, redo OPCAB was in 49 patients (77%) and their STS PROM and Euroscore II were 2.91% (IQR 0.80-5.75) and 5.76% (IQR 3.02-12.59). Survival outcome and patency from coronary CT angiography at postoperative median 1.2 years (IQR 0.02-3.04) exam in 50 patients (78%) were analyzed.

 

RESULTS: Overall mean survival time was 5.517 years (95% C.I. 4.694-6.340) and 1-,3-,5-year survival rates were 81%, 79%, 70%, respectively. Cardiac-death free MST was 7.137 years (95% C.I. 6.654-7.620) and 1-,3-,5-YSRs were 95%, 95%, 95%, respectively. MACE-free MST was 6.357 years (95% C.I. 5.609-7.105) and 1-,3-,5-YSRs were 95%, 90%, 78%, respectively. Overall mean patent time was 4.707 years (95% C.I. 4.086-5.329) and 1-,3-,5-year patency rates were 95%, 84%, 84%, respectively.

CONCLUSIONS: Conducting minimally invasive off-pump subclavian artery to coronary bypass grafting could be feasible, and its mid-term results are acceptable.