Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra-and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.

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“…Two papers in our review did not describe one of the above methods specifically but a mix of different methods (83,84).…”

Section: Mixed Seriesmentioning

confidence: 99%

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Bonatti¹,

Wallner²,

Crailsheim³

et al. 2021

J Thorac Dis

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“…Consistent with prior published literature on MICABG, perioperative morbidity was shown to be reduced following MICABG compared with conventional sternotomy CABG in the present study. 5,10 Significantly reduced odds of postoperative blood product transfusion, reduced duration of mechanical ventilation, and reduced duration of postoperative hospitalization are particularly noteworthy (Tables 3, 4). Most important, however, is that no postoperative morbid event evaluated was higher in the MICABG group than in the conventional CABG group.…”

Section: Discussionmentioning

confidence: 98%

Reduced Morbidity and Mortality Associated With Minimally Invasive Single-vessel Coronary Artery Bypass Compared With Conventional Sternotomy

et al. 2022

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Objective: We aimed to describe the safety and clinical benefits of minimally invasive, nonsternotomy coronary artery bypass grafting (MICABG) using data from The Society of Thoracic Surgeons (STS) National Database. Background: MICABG has gained popularity, owing to expected lower perioperative morbidity and shorter recovery. Despite this, concerns remain regarding anastomotic quality and the validity of proposed perioperative benefits. Methods: We queried the STS National Database for all patients who underwent single-vessel coronary artery bypass grafting (CABG) from January 2014 to December 2016 to compare outcomes of MICABG with conventional CABG. Patients who underwent concomitant or emergent procedures were excluded. Propensity-weighted cohorts were compared by operative approach with adjustment for variability across institutions. Results: Of 12,406 eligible patients, 2688 (21.7%) underwent MICABG, and 9818 (78.3%) underwent conventional CABG. Propensity weighting produced excellent balance in patient characteristics, including completeness of revascularization, body mass index, and STS predictive risk scores. MICABG was associated with significant reduction of in-hospital mortality [odds ratio (OR)=0.32, absolute reduction (AR)=0.91%, P<0.0001]; 30-day mortality (OR=0.51, AR=0.88%, P=0.001), duration of ventilation (8.62 vs 12.6 hours, P<0.0001), prolonged hospitalization (OR=0.77, AR=1.6, P=0.043), deep wound infection (OR=0.33, AR=0.68, P<0.004), postoperative transfusions (OR=0.52, AR=7.7%, P<0.0001), and STS composite morbidity (OR=0.72, AR=1.19%, P=0.008). Subgroup analysis of only off-pump left internal mammary artery-left anterior descending CABG showed similar findings. Major adverse cardiac events and graft occlusion did not differ between groups. Conclusions: MICABG is associated with lower mortality and perioperative morbidity compared with conventional sternotomy CABG. MICABG may have a role in treating single-vessel disease.

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