ISMICS Home  |  2022 Scientific Annual Meeting  |  Past & Future Meetings
International Society For Minimally Invasive Cardiothoracic Surgery

Back to 2021 ePosters


Minimally Invasive Direct Coronary Artery Bypass is Associated with Superior Survival in Multivessel Disease: A Network Meta-analysis
Jef Van den Eynde1, Dries No1, Xander Jacquemin1, Paulien Marchal1, Katrien Bomhals1, Keir McCutcheon1, Johan Bennett1, Johannes Bonatti2, Wouter Oosterlinck1
1University Hospitals of Leuven, Leuven, Belgium, 2Krankenhaus Wien Nord - Vienna North Hospital, Vienna, Austria

BACKGROUND: Treatment modalities for multivessel coronary artery disease have rapidly expanded in recent years, including on-pump (ONCAB) and off-pump coronary artery bypass (OPCAB), minimally invasive coronary artery bypass (MIDCAB), percutaneous coronary intervention (PCI), and hybrid coronary revascularization (HCR). However, it remains controversial which strategy provides optimal long-term outcomes.
METHODS: PubMed/MEDLINE, Embase, Cochrane Controlled Trials Register (CENTRAL/CCTR), and reference lists of relevant articles were searched for observational studies and randomized controlled trials (RCTs) published up to August 2020. Data on mortality at long-term follow-up (>12 months) were collected. A Bayesian network meta-analysis was performed.
RESULTS: One hundred twenty-three studies including 231,929 patients (ONCAB: 117,516 patients; OPCAB: 15,040 patients; MIDCAB: 262; PCI: 96,951 patients; HCR: 120 patients) met the eligibility criteria. The network meta-analysis demonstrated that MIDCAB was associated with a significant reduction in long-term mortality compared with ONCAB (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.87), OPCAB (OR 0.53, 95% CI 0.34-0.78), and PCI (OR 0.50, 95% CI 0.32-0.74). HCR performed significantly better than OPCAB (OR 0.77, 95% CI 0.64-0.93) and PCI (OR 0.73, 95% CI 0.60-0.88). ONCAB showed significantly lower mortality than OPCAB (OR 0.90, 95% CI 0.87-0.93) and PCI (OR 0.85, 95% CI 0.84-0.87). Lastly, OPCAB showed superior results compared to PCI (OR 0.95, 95% CI 0.92-0.98). Bayesian Markov chain Monte Carlo modelling showed that MIDCAB had the highest probability of being ranked first with regard to survival [surface under the cumulative ranking curve (SUCRA) probability: 95.4%], while HCR was most likely to be ranked as the second most effective strategy (SUCRA probability: 90.8%).
CONCLUSIONS: MIDCAB seems to be superior in terms of improved overall long-term survival and might thus be a promising strategy for the treatment of multivessel coronary artery disease, but RCTs are needed.


Back to 2021 ePosters

By using this site, you agree to our updated Privacy Policy.  Got it