N. J. Smith1, M. Cain1, B. Miles1, P. Pearson1, L. Joyce1, L. Durham1, G. Raikar1, C. Rokkas1, D. Joyce1 1Medical College Of Wisconsin,Cardiothoracic Surgery,Milwaukee, WI, USA
Introduction: Coronary artery bypass grafting (CABG) can be performed through a variety of approaches. Minimally invasive, non-sternotomy CABG has been proposed as a technique to reduce perioperative morbidity. Early data demonstrate improvements in perioperative metrics, however, adoption has been limited due to limited institutional experience.
Methods: The Society of Thoracic Surgeons (STS) database at a single academic institution was queried for all isolated single-vessel left internal mammary to left anterior descending artery (LIMA-LAD) bypass procedures performed between January 2011 and March 2018. Patients were grouped based on operative approach, comparing conventional sternotomy to non-sternotomy (minimally-invasive) approaches. Patients who underwent concomitant valvular, aortic, or ablative procedures were excluded. Patient characteristics, perioperative variables, and short term outcomes were compared between groups. Primary outcome included mortality and major adverse cardiac events, with postoperative morbidity as secondary outcomes.
Results: A total of 48 minimally-invasive and 68 conventional sternotomy single-vessel LIMA-LAD CABG procedures were performed. Minimally-invasive approaches were more often elective (81.3 vs 52.9%, p=0.002). Patient characteristics were similar between groups. STS predicted risk scores demonstrated similar predicted mortality between groups with significantly lower predicted rates of prolonged ventilation, renal failure, and long length of stay in the minimally-invasive group. No significant difference was noted in major adverse cardiac events (0.0 vs 7.4%, p=0.076), STS composite morbidity (2.1 vs 8.6%, p=0.237), and postoperative myocardial infarction (4.2 vs 1.5%, p=0.569). Minimally-invasive approach was associated with fewer pulmonary (0.0 vs 10.3%, p=0.040) complications and decreased ICU (34.95 vs 58.7 hours, p<0.001) and total length of stay (4.54 vs 8.04 days, p<0.001). There were no observed strokes or graft occlusion reoperation in either group. There was a trend toward reduced 30-day mortality (100 vs 92.6%, p=0.076). These are consistent with previous experiences.
Conclusion: Minimally-invasive single-vessel LIMA-LAD CABG demonstrates improved perioperative outcomes regarding length of stay and pulmonary complications while performing comparably to conventional sternotomy in mortality and major adverse cardiac events. In select patients, minimally-invasive approaches to single-vessel grafting may be beneficial and a safe alternative to conventional approaches.