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Reduced Morbidity and Mortality Associated With Minimally Invasive Single-vessel Coronary Artery Bypass Compared With
Michael T Cain1, David L Joyce2, Aniko Szabo3
1Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Annals of Surgery
|July 7, 2022
Summary
Minimally invasive, nonsternotomy coronary artery bypass grafting (MICABG) shows reduced mortality and perioperative complications compared to conventional sternotomy CABG. This approach is a viable option for single-vessel coronary artery disease treatment.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Minimally invasive, nonsternotomy coronary artery bypass grafting (MICABG) is increasingly adopted due to anticipated reductions in perioperative morbidity and recovery time.
- Concerns persist regarding the quality of anastomoses and the validated perioperative benefits of MICABG compared to traditional methods.
Purpose of the Study:
- To evaluate the safety and clinical advantages of MICABG.
- To compare outcomes of MICABG versus conventional sternotomy coronary artery bypass grafting (CABG) for single-vessel disease.
Main Methods:
- Analysis of The Society of Thoracic Surgeons (STS) National Database for single-vessel CABG procedures performed between January 2014 and December 2016.
- Exclusion of patients undergoing concomitant or emergent procedures.
- Comparison of propensity-weighted cohorts undergoing MICABG versus conventional CABG, adjusting for institutional variability.
Main Results:
- MICABG was associated with significantly lower in-hospital mortality (OR=0.32), 30-day mortality (OR=0.51), duration of ventilation, prolonged hospitalization, deep wound infection, and need for postoperative transfusions.
- The STS composite morbidity was also significantly reduced in the MICABG group (OR=0.72).
- No significant differences were observed in major adverse cardiac events or graft occlusion between the MICABG and conventional CABG groups.
Conclusions:
- MICABG demonstrates a favorable safety profile with reduced mortality and perioperative morbidity compared to conventional sternotomy CABG.
- MICABG represents a potentially valuable therapeutic option for patients with single-vessel coronary artery disease.
