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Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease: A Systematic Review
Davorin Sef1, Myat Soe Thet2, Shahrul Amry Hashim3
1Department of Cardiac Surgery, University Hospitals of Leicester, UK.
Insights
Minimally invasive coronary artery bypass grafting (MICS CABG) is a safe option for select patients with multivessel coronary artery disease. Further research is needed to compare MICS CABG outcomes with conventional methods.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Coronary Artery Disease Management
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for multivessel coronary artery disease (CAD).
- Minimally invasive techniques offer potential benefits over traditional open-chest surgery.
- The feasibility and safety of minimally invasive coronary artery bypass grafting (MICS CABG) for multivessel CAD require comprehensive evaluation.
Purpose of the Study:
- To systematically review the existing evidence on the feasibility and safety of MICS CABG in patients with multivessel CAD.
- To assess the outcomes associated with MICS CABG in this patient population.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, MEDLINE, Embase, Scopus, Web of Science).
- Studies included were those evaluating MICS CABG outcomes in patients with multivessel CAD, with a minimum of 15 patients per study.
- No restrictions were placed on the publication date.
Main Results:
- Twenty-six studies involving 7,556 patients met the eligibility criteria.
- The average patient age was 63.3 years, with 77.8% males and a BMI of 29.8 kg/m².
- Key outcomes included low early mortality (0.6%) and stroke rates (0.4%), with an average of 2.8 grafts and a 5.6-day hospital stay.
Conclusions:
- MICS CABG demonstrates safety and feasibility in carefully selected patients with multivessel CAD.
- While currently concentrated in specialized centers, MICS CABG holds potential as a widely applicable alternative surgical revascularization strategy.
- Larger randomized controlled trials with extended follow-up are necessary to definitively compare MICS CABG with conventional CABG and other revascularization methods.
Objective:
We conducted a systematic review of all available evidence on the feasibility and safety of minimally invasive coronary artery bypass grafting (MICS CABG) in patients with multivessel coronary artery disease (CAD).
Methods:
A systematic literature search in PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science was performed to identify all relevant studies evaluating outcomes of MICS CABG among patients with multivessel CAD and including at least 15 patients with no restriction on the publication date.
Results:
A total of 881 studies were identified, of which 26 studies met the eligibility criteria. The studies included a total of 7,556 patients. The average patient age was 63.3 years (range 49.5 to 69.0 years), male patients were an average of 77.8% (54.0% to 89.8%), and body mass index was 29.8 kg/m2 (24.5 to 30.1 kg/m2). Early mortality and stroke were on average 0.6% (range 0% to 2.0%) and 0.4% (range 0% to 1.3%), respectively. The average number of grafts was 2.8 (range 2.1 to 3.7). The average length of hospital stay was 5.6 days (range 3.1 to 9.3 days).
Conclusions:
MICS CABG appears to be a safe method in well-selected patients with multivessel CAD. This approach is concentrated at dedicated centers, and there is no widespread application, although it has potential to be widely applicable as an alternative for surgical revascularization. However, large randomized controlled studies with longer follow-up are still required to compare the outcomes with conventional CABG and other revascularization strategies.
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