Introduction This study aims to compare the outcomes of minimally invasive coronary artery bypass grafting surgery (MICS CABG) versus median sternotomy (MS CABG) within an established minimally invasive cardiac surgical programme in Singapore. Methods We retrospectively analysed 111 propensity-score matched pairs of patients who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass (MIDCAB) patients were matched to single or double graft MS CABG patients (Group 1) while multivessel MICS patients were matched to MS CABG patients with the corresponding number of grafts (Group 2). Results 111 propensity matched pairs were obtained. The EuroSCORE II in the matched group cohorts were comparable (p=0.846). In both single and multivessel groups, MICS patients experienced shorter postoperative length of stay (p<0.001) and lower rates of prolonged ventilation (p=0.041) . Intraoperative transfusion rates and other postoperative outcomes were comparable between MICS and MS patients in the single and multivessel groups.mortality, reintervention heart failure rates were also comparable at 1 year follow up. In Group 1, no significant differences in procedural duration (p=0.574) and cardiopulmonary bypass duration (p=0.699) were noted. Moreover, MIDCAB patients had a smaller drop in postoperative haemoglobin levels (p<0.001). In Group 2, cardiopulmonary bypass (p=0.097) and length of procedure (p<0.001) were longer among multivessel MICS patients but did not translate to adverse postoperative events. Conclusion MICS CABG is a safe and effective approach for surgical revascularisation of coronary artery disease.

Background Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before PCI. However, whether FFR assessment should be routinely used before CABG remains unclear. Our aim was to compare the outcomes of using FFR with that of conventional CAG (coronary angiography) in guiding CABG. Method This systematic review and meta-analysis was performed according to the PRISMA guidelines. Six studies were included, of which four were double-arm (two prospectively randomised) and two single-arm, reporting data on 1931 patients. A meta-analysis was done for double-arm studies, comparing rates of overall death, MACCE, target vessel revascularisation, spontaneous MI and graft patency. The data of all six studies were entered in a pooled analysis for the endpoints of overall death, spontaneous MI and target vessel revascularisation. Results Meta-analysis demonstrated significantly lower death rates in the FFR-guided than the CAG-guided group (p=0.03) and no significant differences in the rates of MACCE, target vessel revascularisation, spontaneous MI and graft patency. In pooled analysis, FFR-guided group was linked with lower rates of overall death and spontaneous MI. Graft occlusion rate was significantly lower after FFR in one retrospective study, however, this difference was lost in meta-analysis (p=0.24). Conclusion In this meta-analysis, FFR-guided CABG was associated with lower overall death rate and was, at least, non-inferior in the endpoints of MACCE, target vessel revascularisation, spontaneous MI and graft patency than CAG-guided CABG. Further randomized trials are needed to define the role of FFR in guiding CABG surgery.