Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease...

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.