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Short and Long Term Results of Minimally Invasive Direct Coronary Artery Bypass Versus Full Sternotomy Revascularization in Isolated Left Anterior Descending Artery Disease: a Propensity Score Adjusted Comparison
Eman Alkizwini, MBBS, Umberto Benedetto, PhD, Shahzad G. Raja, FRCS(C-Th), Mohamed Amrani, PhD.
Harefield Hospital, London, United Kingdom.

OBJECTIVE: Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed as an attractive alternative to full sternotomy (FS) revascularization in isolated left anterior descending (LAD) artery disease not suitable for percutaneous coronary intervention. However, surgeons are still reluctant to perform MIDCAB owing to concerns about early and late outcomes. We aimed to compare short and long term outcomes after MIDCAB versus FS revascularization.
METHODS: Prospectively collected data from institutional database were reviewed. Data for late mortality was obtained from the General Register Office. MIDCAB was performed in 316 patients while 161 had FS, according to the surgeon’s preference, among 477 patients with isolated LAD disease. Inverse propensity score weighting was used to estimate treatment effects on short and long term outcomes.
RESULTS: In the propensity score adjusted analysis, MIDCAB versus FS revascularization was associated with a trend towards better short term results including operative mortality (0.6% vs 1.6%; P=.2), postoperative dialysis (1.5% vs 4.5%; P=.09), re-intubation (0.9% vs 3.3%;P=.1) and surgical site wound infection (0.1% vs 1.2%; P=0.04). Mean length of hospital stay did not differ between the two groups. After a mean follow/up time of 2220 days (range 3 to 4450), MIDCAB did not affect late mortality (HR 0.70; 95%CI 0.27-1.82; P=0.47), need for repeat revascularization (HR 1.26; 95%CI 0.50 - 3.13; P=0.62) and the composite of death and repeat revascularization (HR 0.94; 95%CI 0.49 - 1.49; P=0.92).
CONCLUSIONS: MIDCAB was associated with a trend towards better short term outcomes and excellent long term results comparable to FS revascularization. According to these findings, surgeons should not be reluctant to perform MIDCAB in isolated LAD disease.

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