Minimally Invasive Direct Coronary Artery Bypass: An Evolving Paradigm Over the Past 25 Years

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Coronary Artery Bypass Grafting

Background:

• Minimally invasive direct coronary artery bypass (MIDCAB) is a standard procedure for revascularizing the left anterior descending (LAD) artery.
• Evolution of MIDCAB techniques and outcomes over time is crucial for understanding advancements in cardiac surgery.

Purpose of the Study:

• To analyze the evolution of the minimally invasive direct coronary artery bypass (MIDCAB) procedure.
• To compare patient risk profiles and short-term outcomes of MIDCAB over different time periods.

Main Methods:

• Retrospective review of 2,283 consecutive MIDCAB patients from 1997 to 2021.
• Patients categorized into three groups based on surgical era (1997-2002, 2003-2009, 2009-2021).
• Propensity-matched analysis of 293 patients from each group to compare outcomes.

Main Results:

• The later era (Group C) featured robotic assistance for left internal mammary artery harvesting, unlike the earlier open technique in Group A.
• Group A patients exhibited higher rates of comorbidities such as peripheral vascular disease, congestive heart failure, and stroke history.
• Thirty-day mortality and stroke incidence were significantly higher in Group A compared to Group C, with these differences persisting after propensity matching.

Conclusions:

• Minimally invasive direct coronary artery bypass (MIDCAB) patient populations have seen a reduction in comorbidities over time.
• The adoption of robot-assisted techniques in MIDCAB is associated with a lower risk of stroke.