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Updated: Dec 11, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Very Long-term Outcome of Minimally Invasive Direct Coronary Artery Bypass
Giorgio Mastroiacovo1, Sabrina Manganiello2, Sergio Pirola2
1Department of Cardiovascular Surgery, Monzino Cardiology Center Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers excellent long-term survival and freedom from major adverse cardiocerebral-related events (MACCE). This approach also reduces hospital stay and blood transfusions compared to traditional sternotomy.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Long-Term Outcomes
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is a surgical technique for revascularizing the left descending coronary artery.
- This procedure utilizes the left internal mammary artery and is considered low-impact.
Purpose of the Study:
- To evaluate the safety and long-term efficacy of MIDCAB.
- Assess overall survival rates up to 20 years post-procedure.
- Determine freedom from major adverse cardiocerebral-related events (MACCE) after two decades.
Main Methods:
- Retrospective analysis of 141 patients undergoing MIDCAB between 1997 and 2017.
- Focus on 133 patients who had left descending coronary artery revascularization using the left mammary artery via full median sternotomy.
- Kaplan-Meier curves and Cox multivariable analysis were employed for outcome assessment.
Main Results:
- Actuarial survival rates reached 70% at 20 years.
- Freedom from MACCE (myocardial infarction, stroke, cardiac death) was 61% at 20 years.
- MIDCAB demonstrated significantly shorter hospital stays and fewer blood transfusions compared to full sternotomy.
Conclusions:
- MIDCAB provides satisfactory very long-term clinical outcomes regarding survival and MACCE.
- The procedure significantly reduces hospital length of stay and blood transfusions.
- MIDCAB appears to improve prognosis for cardiac-related and all-cause events compared to full sternotomy.
Background:
Minimally invasive direct coronary artery bypass (MIDCAB) is a well-established, low-impact surgical procedure for revascularization of the left descending coronary artery with the left internal mammary artery. This study aimed to evaluate safety, overall survival, and freedom from major adverse cardiocerebral-related events (MACCE) after 20 years of MIDCAB.
Methods:
This study retrospectively collected a series of 141 patients who underwent MIDCAB between 1997 and 2017, to assess long-term outcome. A total of 133 patients who underwent revascularization of the left descending coronary artery with the left mammary artery through a full median sternotomy were analyzed.
Results:
Actuarial survival rates on a Kaplan-Meier curve were 100%, 95%, 90%, 83%, and 70% at 1, 5, 10, 15, and 20 years, respectively. Freedom from MACCE, defined as myocardial infarction, stroke, and cardiac death, was 97%, 90%, 79%, 75%, and 61% at 1,5,10,15, and 20 years, respectively. At Cox multivariable analysis, age, cancer, and chronic renal insufficiency were found to be independent predictors affecting long-term survival, with a hazard ratio of 1.12 (P = .007), 17.63 (P < .001), and 5.16 (P = .03), respectively. The MIDCAB group showed a significantly shorter hospital length of stay and significantly lower rates of blood transfusions, cardiac-related events, and all-cause events compared with the full sternotomy group (P = .02 and P = .001, respectively).
Conclusions:
The very long-term clinical outcome of MIDCAB is satisfactory in terms of survival and freedom from MACCE. MIDCAB significantly reduces hospital length of stay and blood transfusions when compared with full sternotomy bypass surgery on the left descending coronary artery and appears to improve prognosis in terms of cardiac-related events and all-cause events effectively.
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