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Published on: September 15, 2023
Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers comparable outcomes to off-pump coronary artery bypass (OPCAB) surgery. MIDCAB may lead to a shorter hospital stay and reduced blood transfusion needs, indicating faster recovery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Cardiac Bypass Surgery
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is underutilized in the UK.
- Comparison of MIDCAB with standard median sternotomy off-pump coronary artery bypass (OPCAB) is warranted.
Purpose of the Study:
- To compare the outcomes of MIDCAB with single-vessel OPCAB surgery.
- To evaluate the safety and efficacy of MIDCAB in selected patients.
Main Methods:
- Retrospective review of 74 MIDCAB and 78 OPCAB patients (April 2008 - July 2011).
- Exclusion criteria: ejection fraction <0.5 or prior cardiac surgery.
- Data collected from prospective database, medical records, and general practitioners.
Main Results:
- No significant differences in mortality, reinfarction, stroke, infection, or reintervention between MIDCAB and OPCAB.
- MIDCAB group had fewer conversions to sternotomy (6) compared to OPCAB.
- MIDCAB showed a significantly reduced mean hospital stay (6.1 vs 8.5 days) and lower average blood transfusion units (1.8 vs 3.2).
Conclusions:
- MIDCAB is a safe and effective alternative for appropriately selected patients.
- MIDCAB offers benefits of shorter hospital stay, reduced blood transfusion, and faster recovery.
- Outcomes of MIDCAB are comparable to OPCAB surgery.
Introduction:
Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy.
Methods:
Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners.
Results:
Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05).
Conclusions:
MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.
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