Related Experiment Video
Updated: Apr 7, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Propensity Score Adjusted Comparison of MIDCAB Versus Full Sternotomy Left Anterior Descending Artery
Shahzad G Raja1, Umberto Benedetto, Eman Alkizwini
1From the Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) shows a trend toward better short-term outcomes and comparable long-term results to full sternotomy (FS) revascularization for isolated left anterior descending artery disease. Surgeons can confidently consider MIDCAB.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Coronary Artery Disease
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is an alternative to full sternotomy (FS) for isolated left anterior descending (LAD) artery disease.
- Surgeon reluctance persists due to concerns about MIDCAB's early and late outcomes.
Purpose of the Study:
- To compare short- and long-term outcomes of MIDCAB versus FS revascularization.
- To evaluate the safety and efficacy of MIDCAB in patients with isolated LAD disease.
Main Methods:
- Prospective data from an institutional database were reviewed.
- Inverse propensity score weighting was used to adjust for confounding factors.
- Late mortality data were obtained from the General Register Office.
Main Results:
- FS revascularization was associated with a higher rate of surgical site infection compared to MIDCAB (2.8% vs 0.7%).
- No significant differences were observed in operative mortality or length of hospital stay between groups.
- After a mean follow-up of 6.2 years, FS did not show improved late survival or reduced need for repeat revascularization compared to MIDCAB.
Conclusions:
- MIDCAB demonstrated a trend toward better short-term outcomes.
- Long-term results for MIDCAB were comparable to FS revascularization.
- MIDCAB is a viable option for isolated LAD disease, and surgeons should not hesitate to perform it.
Objective:
Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed as an attractive alternative to full sternotomy (FS) revascularization in isolated left anterior descending (LAD) artery disease not suitable for percutaneous coronary intervention. However, surgeons are still reluctant to perform MIDCAB owing to concerns about early and late outcomes. We aimed to compare short- and long-term outcomes after MIDCAB versus FS revascularization.
Methods:
Prospectively collected data from institutional database were reviewed. Data for late mortality were obtained from the General Register Office. MIDCAB was performed in 318 patients, whereas 159 had FS, according to the surgeon's preference, among 477 patients with isolated LAD disease. Inverse propensity score weighting was used to estimate treatment effects on short- and long-term outcomes.
Results:
In the propensity score-adjusted analysis, FS revascularization versus MIDCAB was associated increased rate of surgical site infection [4 (2.8%) versus 1 (0.7%); P = 0.04]. The 2 groups did not significantly differ with regard to other complications including operative mortality. Mean length of hospital stay was similar for the 2 groups. After a mean follow-up time of 6.2 years (interquartile range, 3.5-9.7 years), compared to MIDCAB, FS was not associated with an improved late survival (β coef, -1.42; standard error, 1.65; P = 0.39) or risk reduction for repeat revascularization (β coef, 1.22; standard error, 1.41; P = 0.15).
Conclusions:
MIDCAB was associated with a trend toward better short-term outcomes and excellent long-term results comparable to FS revascularization. According to these findings, surgeons should not be reluctant to perform MIDCAB in isolated LAD disease.
