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=11

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=<sec><title>Objectives</title><p>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 follow-up is scarce. We compared short- and long-term results of MIDCAB vs. FS-OPCAB revascularization over a maximum follow-up period of 10 years.</p></sec><sec><title>Patients and methods</title><p>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 probability of treatment weighting (IPTW) was used to adjust for selection bias and to estimate treatment effects on short- and long-term outcomes. IPTW-adjusted 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 follow-up of 10 years.</p></sec><sec><title>Results</title><p>MIDCAB patients had less rethoracotomies (<italic>n</italic> = 13/3.6% vs. <italic>n</italic> = 30/8.0%, <italic>p</italic> = 0.012), fewer transfusions (0.93 units ± 1.83 vs. 1.61 units ± 2.52, <italic>p</italic> &lt; 0.001), shorter mechanical ventilation time (7.6 ± 4.7 h vs. 12.1 ± 26.4 h, <italic>p</italic> = 0.005), and needed less hemofiltration (<italic>n</italic> = 0/0% vs. <italic>n</italic> = 8/2.4%, <italic>p</italic> = 0.004). Thirty-day mortality did not differ significantly between the two groups (<italic>n</italic> = 0/0% vs. <italic>n</italic> = 3/0.8%, <italic>p</italic> = 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, <italic>p</italic> = 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, <italic>p</italic> = 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, <italic>p</italic> = 0.22).</p></sec><sec><title>Conclusion</title><p>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.</p></sec>