Minimally-invasive coronary artery bypass grafting offers superior
outcomes compared to conventional median sternotomy: a propensity-score
matched study
Abstract
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.