Minimally Invasive Versus Conventional Coronary Artery Bypass Grafting-early Results Of A Multicenter Prospective Study In China
Yuqian Xie1, Liyue Zhang1, Rong Wang2.
1Medical School of Chinese PLA, Beijing, China, 2The Sixth Medical Center of PLA General Hospital, Beijing, China.
BACKGROUND: Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) is spreading increasingly around the world and its safety and efficiency has been demonstrated by a series of cohort studies. However, no prospective study has been conducted to compare the results between MICS-CABG and Conventional CABG (CCABG) to date.
METHODS: This is a multi-center prospective study involving four teaching hospitals in Beijing, China-PLA General Hospital, Peking University Third Hospital, Beijing Anzhen Hospital and Peking University People's Hospital. A total of 408 patients with multi-vessel coronary artery disease (MV-CAD) were consecutively enrolled based on the patient selection criterion from October 2020 to April 2022. After preoperative assessment and physician-patient selection, 190 patients (150 men and 40 women, aged 62.7±9.8 years) underwent MICS-CABG and 218 patients (162 men and 56 women, aged 62.7± 8.4 years) underwent CCABG (70% OFF-PUMP CABG). The peri-operative data and follow-up data were recorded, and propensity score matching analysis was utilized to compare the results between the groups.
RESULTS: Between the MICS-CABG group and CCABG group, there was no difference in the LIMA utilization rate (95.3% vs 90.8%, P=0.082). The mean anastomosis number was less in the MICS-CABG group than that in the CCABG group (2.8 vs 3.2, P<0.001). There was no death, myocardial infarction, stroke and repeat revascularization within 30 days after surgery. Intraoperative red blood cell utilization was less in the MICS CABG group compared to the CCABG group (11.6% vs 20.2%, p=0.026). During the follow-up period, 4 patients were lost with a follow-up rate of 99%. There was no statistical difference in all-cause death (0.5% vs 0.9%, P=1.000), non-fatal heart attack (0.5% vs 0, P=0.945), stroke (0.5% vs 1.4%, P=0.716) and no repeat revascularization between the MICS-CABG group and CCABG group during a mean follow-up period of 402 days.
CONCLUSIONS: MICS-CABG showed similar perioperative and postoperative 1-year results as CCABG for MV-CAD despite of less anastomosis number. Long-term follow-up results and graft patency evaluation are warranted in the future study.
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