AUTHOR=Sharaf Mohammad , Zittermann Armin , Sunavsky Jakub , Gilis-Januszewski Tomasz , Rojas Sebastian V. , Götte Julia , Opacic Dragan , Radakovic Darko , El-Hachem Georges , Razumov Artyom , Renner Andre , Gummert Jan F. , Deutsch Marcus-André 

TITLE=Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1298466

DOI=10.3389/fcvm.2024.1298466

ISSN=2297-055X

ABSTRACT=Objectives: Minimally-invasive direct coronary artery bypass (MIDCAB) is a less-invasive alternative to full sternotomy off-pump coronary artery bypass (FS-OPCAB) revascularization of the left anterior descending artery (LAD). Some studies suggested that MIDCAB is associated with a greater risk of graft occlusion and repeat revascularization than FS-OPCAB LIMA-to-LAD grafting. Data comparing MIDCAB to FS-OPCAB with regard to long-term followup is scarce. We compared short-and long-term results of MIDCAB versus FS-OPCAB revascularization over a maximum follow-up period of 10 years. Patients and methods: From December 2009 to June 2020, 388 elective patients were included in our retrospective study. 229 underwent MIDCAB, and 159 underwent FS-OPCAB LIMA-to-LAD grafting. Inverse propensity score weighting (IPTW) was used to adjust for selection bias and to estimate treatment effects on short-and long-term outcomes. IPTWadjusted Kaplan-Meier estimates by study group were calculated for all-cause mortality, stroke, the risk of repeat revascularization and myocardial infarction up to a maximum followup of 10 years.Results: MIDCAB patients had less rethoracotomies (n=13/3.6% vs. n=30/8.0%, p=0.012), fewer transfusions (0.93units±1.83 vs. 1.61 units±2.52, p<0.001), shorter mechanical ventilation time (7.6±4.7 hrs vs. 12.1±26.4hrs, p=0.005), and needed less hemofiltration (n=0/0% vs. n=8/2.4%, p=0.004). 30-day mortality did not differ significantly between the two groups (n=0/0% vs. n=3/0.8%, p=0.25). Long-term outcomes did not differ significantly between study groups. In the FS-OPCAB group, the probability of survival at 1, 5, and 10 years was 98.4%, 87.8%, and 71.7%, respectively. In the MIDCAB group, the corresponding values were 98.4%, 87.7%, and 68.7%, respectively (RR1.24, CI0.87-1.86, p=0.7). In the FS group, the freedom from stroke at 1, 5, and 10 years was 97.0%, 93.0%, and 93.0%, respectively. In the MIDCAB group, the corresponding values were 98.5%, 96.9%, and 94.3%, respectively (RR0.52, CI0.25-1.09, p=0.06). Freedom from repeat revascularization at 1, 5, and 10 years in the FS-OPCAB group was 92.2%, 84.7%, and 79.5%, respectively. In the MIDCAB group, the corresponding values were 94.8%, 90.2%, and 81.7%, respectively (RR0.73, CI0.47-1.16, p=0.22).MIDCAB is a safe and efficacious technique and offers comparable long-term results regarding mortality, stroke, repeat revascularization, and freedom from myocardial infarction when compared to FS-OPCAB.