Completed and ongoing trials in minimally invasive cardiac surgery coronary surgery

Minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG), first established two decades ago, offers multivessel revascularization via a small left anterior thoracotomy and without the need for cardiopulmonary bypass, potentially leading to lower complication rates and faster recovery. However, adoption of MICS CABG has been slow, in part due to lack of randomized trial data. Here, we review important retrospective studies, as well as ongoing and completed MICS CABG trials.

The majority of studies remain single-center observational studies demonstrating that MICS CABG yields comparable perioperative morbidity and mortality to conventional CABG, with excellent angiographic graft patency, comparable long-term outcomes and faster recovery times. There are two ongoing randomized controlled trials, the MIST and MICS-CABG PRPP trials, both comparing quality of life and recovery in the early postoperative period between patients undergoing MICS CABG versus sternotomy CABG.

The MIST and MICS-CABG PRPP trials will for the first time provide prospective, randomized data on the benefits of MICS CABG. However, both trials involve highly experienced MICS CABG surgeons. As such, the findings will likely not be generalizable to the general cardiac surgery community and MICS CABG will remain a boutique operation offered in highly specialized centers.