Ryohei Ushioda, n/a: No financial relationships to disclose
Purpose: At our institution, off-pump coronary artery bypass (OPCAB) is the standard procedure, and minimally invasive cardiac surgery (MICS) OPCAB is performed on selected patients. We investigated retrospectively to compare early outcomes associated with the safety of multi-vessel coronary disease conducted using MICSOPCAB or conventional off-pump techniques. Methods: A total of 1315 patients who underwent surgical coronary revascularization at a single center between August 2017 and September 2022 were analyzed retrospectively. Patients with single coronary bypass were excluded, leaving 1220 patients with multi-vessel coronary artery grafting for the analysis. The patients were divided into the MICSOPCAB group (MICS group with 163 patients) and the conventional OPCAB group (MS group with 1057 patients). In addition, the MICSOPCAB group was propensity score-matched (PSM) with those in the OPCAB at a 1:1 ratio (MICS=149; MS=149), and matching was performed based on 23 covariates with preoperative clinical characteristics. Results: After matching, there were no significant differences in operating time(247.9±71.8 min in the MICS group versus 246.2±64.2 min in the MS group; p=0.828) and the number of complete-revascularization (92.6% in the MICS group versus 98.7% in the MS group; p=0.521) in the operation time between the two groups, but the total graft number (2.3±0.6 in the MICS group versus 2.9±0.8 in the MS group; p< 0.001) and the mean number of distal anastomoses (2.7±0.8 in the MICS group versus 3.2±0.9 in the MS group; p< 0.001) were higher in the MS group. The short-term outcomes of paired groups show no significant differences in hospital stay, Intensive care unit stay, postoperative complications, and the 30 days mortality between the groups. The MICS group was in less drain contents than the MS group (350 [250-500]ml in the MICS group versus 450 [300-550]ml in the MS group, p=0.013). The Kaplan–Meier curve of the postoperative free-from major adverse cardiac or cerebrovascular events (MACCE) rate and survival rate showed no significant differences between the two groups (free from MACCE rate; p=0.945, survival rate; p=0.374). The free-from MACCE rate and survival rate at 1 and 3 years were shown no significant differences between the two groups. Conclusion: With the proper patient selection, MICSOPCAB can provide good short-time results and a complete revascularization rate comparable to those associated with conventional OBCABG, even with multi-vessel lesions. It also offers advantages, including a lower drain count. There were no significant differences in each item between the two groups in terms of their free-from MACCE rate and survival rate after 1 year (free from MACCE rate; p=0.628, survival rate; p=0.868) and 3 years (free from MACCE rate; p=0.375, survival rate; p=0.770). There is possible that MICSOPCAB can provide similar long-term outcomes to conventional OPCAB if complete revascularization can be achieved.
Identify the source of the funding for this research project: This research was conducted without any specific funding source.
