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. 2024 Nov 14;3(2):402-407.
doi: 10.1016/j.atssr.2024.10.024. eCollection 2025 Jun.

Minimally Invasive vs Conventional Coronary Bypass Surgery for Multivessel Coronary Disease

Yichen Gong  1 , Tong Ding  1 , Xiaoxiao Wang  2 , Zhongqi Cui  1 , Hong Zhao  1 , Song Wu  1 , Yuanhao Fu  1 , Hang Yang  1 , Yunpeng Ling  1
Affiliations

Minimally Invasive vs Conventional Coronary Bypass Surgery for Multivessel Coronary Disease

Yichen Gong et al. Ann Thorac Surg Short Rep. .

Abstract

Background: Despite sternum sparing and without cardiopulmonary bypass, the actual value of minimally invasive coronary surgery (MICS) is still debatable. This study aimed to compare the completeness of revascularization and intermediate-term outcomes of MICS with conventional sternotomy coronary artery bypass grafting (CABG).

Methods: Two groups of 244 patients each receiving MICS-CABG and sternotomy-CABG between November 2015 and March 2019 were matched by propensity score matching. The completeness of revascularization and major adverse cardiovascular and cerebrovascular events (MACCE; a composite of death, myocardial infarction, stroke, or repeated target vessel revascularization) were compared between the groups.

Results: In the MICS-CABG group, the percentages of bypassed vessels 2, 3, and ≥4 were 53.7%, 36.1%, and 10.2%, respectively. Completeness of revascularization (95.5% vs 96.3%; P = .65) was comparable between MICS-CABG and sternotomy-CABG groups. Postprocedural angiography revealed an overall patency of 96.2% (578/601) for the MICS-CABG group. At 5 years, rates of MACCE (19.9% vs 22.1%; hazard ratio [HR], 0.80; 95% CI, 0.49-1.32; P = .39), death (10.6% vs 12.9%; HR, 0.87; 95% CI, 0.46-1.65; P = .67), myocardial infarction (5.6% vs 4.2%; HR, 0.82; 95% CI, 0.27-2.52; P = .73), stroke (6.7% vs 6.6%; HR, 1.11; 95% CI, 0.43-2.86; P = .83), and repeated target vessel revascularization (1.9% vs 1.8%; HR, 0.85; 95% CI, 0.17-3.15; P = .84) were similar between MICS-CABG and sternotomy-CABG.

Conclusions: MICS-CABG, which appeared to yield noninferior completeness of revascularization and intermediate-term MACCE compared with sternotomy-CABG, could be an alternative for patients with multivessel coronary diseases.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart of patient selection. (CABG, coronary artery bypass grafting; MICS, minimally invasive coronary surgery.)
Figure 2
Figure 2
Cumulative major adverse cardiac and cerebrovascular events (MACCEs) for minimally invasive coronary surgery (MICS)–coronary artery bypass grafting (CABG) vs sternotomy-CABG (A) before and (B) after matching. (HR, hazard ratio.)
Figure 3
Figure 3
Follow-up 1-, 3-, and 5-year outcomes of minimally invasive coronary surgery (MICS)–coronary artery bypass grafting (CABG) vs sternotomy-CABG group. (HR, hazard ratio; MACCE, major adverse cardiac and cerebrovascular events.)
Figure 4
Figure 4
Cumulative (A) death, (B) myocardial infarction, (C) stroke, and (D) repeated target vessel revascularization for minimally invasive coronary surgery (MICS)–coronary artery bypass grafting (CABG) vs sternotomy-CABG. (HR, hazard ratio.)
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