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Minimally Invasive CABG is Safe and Durable: 10 year Results of the First Thousand Cases
Joseph T. McGinn, Jr.1, Masood A. Shariff1, Maria L. Rodriguez2, John P. Nabagiez1, Marc Ruel2.
1STATEN ISLAND UNIVERSITY HOSPITAL, Northwell Health, STATEN ISLAND, NY, USA, 2University of Ottawa Heart Institute, Ottawa, ON, Canada.

OBJECTIVE: Minimally invasive CABG (MICS CABG) is a non-robotic, multi-vessel CABG performed via small left thoracotomy. Established in 2005, recent studies demonstrate recovery and freedom from infection advantages over OPCAB, a safe learning curve, and excellent graft patency. The purpose of this study is to evaluate the long-term outcomes from a combined two-center experience of the first thousand patients.
METHODS: Patients (N=1,078) underwent MICS CABG through a 4-7 cm thoracotomy in the left 4th or 5th intercostal space. The left internal thoracic artery was harvested under direct vision, proximal anastomoses were constructed on the ascending aorta, and all myocardial territories were accessed for distal anastomoses with an epicardial stabilizer and/or apical positioner. Patients were prospectively followed to evaluate overall survival, MACCE-free survival (cardiac death, non-fatal acute myocardial infarction, repeated target vessel revascularization and stroke) and recurrence of angina.
RESULTS: Patients were followed up to a maximum of 10.5 years (mean 4.6±3.2). At operation, mean patient age was 63.8 ±10.8 years and 253 patients were female (23.4%). Diabetes was prevalent in 325 patients (30%), and 490 (45%) had significant triple vessel disease. A mean of 2.3 ± 1.0 grafts were performed. Peripheral cardiopulmonary bypass without cardioplegic arrest was used in 124 patients (11%) with no major complication. There were 26 (2.6%) conversions to sternotomy.
At mean follow-up, overall late survival after MICS CABG was 96.1%, MACCE-free survival was 93%, and 88% of patients were free from angina.
CONCLUSIONS: MICS CABG offers a safe and reproducible minimally invasive alternative in patients who require CABG. Survival and durability are comparable to conventional CABG with a low rate of complications and conversion to sternotomy.

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