AUTHOR=Ushioda Ryohei , Hirofuji Aina , Yoongtong Dit , Sakboon Boonsap , Cheewinmethasiri Jaroen , Lokeskrawee Thanin , Patumanond Jayanton , Lawanaskol Suppachai , Kamiya Hiroyuki , Arayawudhikul Nuttapon 

TITLE=Multi-vessel coronary artery grafting: analyzing the minimally invasive approach and its safety

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1391881

DOI=10.3389/fcvm.2024.1391881

ISSN=2297-055X

ABSTRACT=<sec><title>Introduction</title><p>At our institution, we perform off-pump coronary artery bypass (OPCAB) as a standard procedure. Moreover, patients with favorable coronary anatomy and condition are selected for minimally invasive cardiac surgery (MICS)-OPCAB. We retrospectively compared early outcomes, focusing on safety, between MICS-OPCAB and conventional off-pump techniques for multivessel coronary artery bypass grafting (CABG).</p></sec><sec><title>Methods</title><p>From August 2017 to September 2022, 1,220 patients underwent multivessel coronary artery grafting at our institution. They were divided into the MICS-OPCAB group (MICS group = 163 patients) and the conventional OPCAB group (MS group = 1057 patients). Propensity score matching (1 : 1 ratio) was applied to the MICS-OPCAB and MS groups (149 patients per group) based on 23 preoperative clinical characteristics.</p></sec><sec><title>Results</title><p>After matching, there were no significant differences in preoperative characteristics between the groups. The MICS group had a lower total graft number (2.3 ± 0.6 vs. 2.9 ± 0.8, <italic>p</italic> &lt; 0.001) and fewer distal anastomoses (2.7 ± 0.8 vs. 3.2 ± 0.9, <italic>p</italic> &lt; 0.001). There were no significant differences in hospital stay, intensive care unit stay, postoperative complications, and 30-day mortality. The MICS group had less drain output (MICS 350 ml [250–500], MS 450 ml [300–550]; <italic>p</italic> = 0.013). Kaplan–Meier analysis revealed no significant differences in postoperative MACCE (major adverse cardiac or cerebrovascular events)-free and survival rates between the groups (MACCE-free rate <italic>p</italic> = 0.945, survival rate <italic>p</italic> = 0.374).</p></sec><sec><title>Conclusion</title><p>With proper patient selection, MICS-OPCAB can provide good short to mid-term results, similar to those of conventional OPCAB.</p></sec>