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Updated: Jun 26, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease
Fleur Sampon1, Joost Ter Woorst1, Lukas Dekker2
1Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Insights
Thoracoscopic-assisted minimally invasive surgery (Endo-CAB) offers improved outcomes for single-vessel Left Anterior Descending disease compared to sternotomy (OPCAB). Patients undergoing Endo-CAB experienced higher rates of textbook outcomes and shorter hospital stays.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Coronary Artery Disease (CAD) management often requires surgical revascularization.
- Minimally invasive techniques aim to reduce surgical trauma and improve patient recovery.
- Off-pump coronary artery bypass (OPCAB) surgery is an established alternative to on-pump procedures.
Purpose of the Study:
- To compare perioperative outcomes between thoracoscopic-assisted (Endo-CAB) and sternotomy (OPCAB) approaches for single-vessel Left Anterior Descending (LAD) disease.
- To evaluate the achievement of 'textbook outcome' in both surgical groups.
- To identify predictors of successful surgical outcomes.
Main Methods:
- Retrospective, propensity-matched cohort study including 266 patients (136 Endo-CAB, 130 OPCAB).
- Propensity score matching created comparable groups of 116 patients each.
- 'Textbook outcome' defined by absence of 30-day mortality, re-exploration, ischemia, tamponade, stroke, infection, arrhythmias, pneumonia, drain placement, and prolonged stay (>7 days).
- Multivariable regression analysis was used to determine predictors of textbook outcome.
Main Results:
- Significantly higher 'textbook outcome' rates in the Endo-CAB group (81.9%) versus OPCAB group (59.5%) (p < 0.001).
- Endo-CAB patients had shorter hospital admission (3.0 vs. 5.0 days, p < 0.001) and less blood loss (225 vs. 450 mL, p < 0.001).
- Endo-CAB approach was an independent predictor of achieving textbook outcome (OR 3.02, p < 0.001).
Conclusions:
- Endoscopic minimally invasive coronary artery bypass grafting (Endo-CAB) improves perioperative outcomes for single-vessel LAD disease.
- Higher rates of 'textbook outcome' observed with Endo-CAB suggest enhanced recovery and fewer complications.
- The widespread availability of standard thoracoscopic instruments supports the potential for broader adoption of the Endo-CAB technique.
Objective:
This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease.
Methods:
In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. 'Textbook outcome' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome.
Results:
Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001).
Conclusions:
Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.
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