The clinical effects of minimally invasive versus conventional coronary artery bypass grafting for coronary heart disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Lin ¹ , MA Xiaolong ¹ , KONG Qingyu ¹ , XIAO Wei ¹ , LIU Jiaji ¹ , HUANG Yu ² , PAN Feng ¹ , GENG Danqing ¹ , ZHAO Guangxin ¹ , ZHU Junming ¹ ,  CHI Liqun ¹

1. Minimally Invasive Heart Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;
2. Chongqing Suining Central Hospital, Chongqing, 629018, P. R. China;

Corresponding author：

CHI Liqun, Email: chiliqun2002@qq.com

Keywords：

Minimally invasive coronary artery bypass grafting; conventional coronary artery bypass grafting; outcomes; retrospective cohort study

DOI：

10.7507/1007-4848.202201016

Video：

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Objective To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. Results The average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). Conclusion Compared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.

Citation： LIANG Lin, MA Xiaolong, KONG Qingyu, XIAO Wei, LIU Jiaji, HUANG Yu, PAN Feng, GENG Danqing, ZHAO Guangxin, ZHU Junming, CHI Liqun. The clinical effects of minimally invasive versus conventional coronary artery bypass grafting for coronary heart disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1430-1435. doi: 10.7507/1007-4848.202201016 Copy

1.	Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2019, 55(1): 4-90.
2.	Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
3.	Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
4.	Ruel M, Shariff MA, Lapierre H, et al. Results of the minimally invasive coronary artery bypass grafting angiographic patency study. J Thorac Cardiovasc Surg, 2014, 147(1): 203-208.
5.	Hannan EL, Wu Y, Cozzens K, et al. Hybrid coronary revascularization versus conventional coronary artery bypass surgery: Utilization and comparative outcomes. Circ Cardiovasc Interv, 2020, 13(10): e009386.
6.	Kikuchi K, Mori M. Minimally invasive coronary artery bypass grafting: A systematic review. Asian Cardiovasc Thorac Ann, 2017, 25(5): 364-370.
7.	Florisson DS, DeBono JA, Davies RA, et al. Does minimally invasive coronary artery bypass improve outcomes compared to off-pump coronary bypass via sternotomy in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg, 2018, 27(3): 357-364.
8.	Kikuchi K, Une D, Suzuki K, et al. Off-pump minimally invasive coronary artery bypass grafting with a heart positioner: Direct retraction for a better exposure. Innovations (Phila), 2015, 10(3): 183-187.
9.	Nakamura Y, Asaumi Y, Miyagi T, et al. Comparison of long-term mortality in patients with previous coronary artery bypass grafting who underwent percutaneous coronary intervention with versus without optimal medical therapy. Am J Cardiol, 2018, 122(2): 206-212.
10.	Honda S, Asaumi Y, Yamane T, et al. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc, 2014, 3(5): e000984.
11.	Ma X, Dong R, Chen P, et al. Percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting: A propensity score matching study. BMC Cardiovasc Disord, 2020, 20(1): 159.
12.	Sakaguchi T, Totsugawa T, Tamura K, et al. Minimally invasive coronary artery bypass grafting: Useful routine option for coronary revascularization in selected cases. Gen Thorac Cardiovasc Surg, 2020, 68(10): 1128-1133.
13.	Saha S, Varghese S, Herr M, et al. Minimally invasive versus conventional extracorporeal circulation circuits in patients undergoing coronary artery bypass surgery: A propensity-matched analysis. Perfusion, 2019, 34(7): 590-597.
14.	Guan Z, Zhang Z, Gu K, et al. Minimally invasive CABG or hybrid coronary revascularization for multivessel coronary diseases: Which is best? A systematic review and meta analysis. Heart Surg Forum, 2019, 22(6): E493-E502.
15.	Kikuchi K, Une D, Kurata A, et al. Off-pump minimally invasive coronary artery bypass grafting using the bilateral internal thoracic arteries and the right gastroepiproic artery. Eur J Cardiothorac Surg, 2016, 49(4): 1285-1286.
16.	Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5): 1469-1477.
17.	Sabashnikov A, Patil NP, Weymann A, et al. Outcomes after different non-sternotomy approaches to left single-vessel revascularization: A comparative study with up to 10-year follow-up. Eur J Cardiothorac Surg, 2014, 46(4): e48-e55.
18.	Une D, Sakaguchi T. Initiation and modification of minimally invasive coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2019, 67(4): 349-354.
19.	Kikuchi K, Une D, Endo Y, et al. Minimally invasive coronary artery bypass grating using bilateral in situ internal thoracic arteries. Ann Thorac Surg, 2015, 100(3): 1082-1084.
20.	Rodriguez ML, Lapierre HR, Sohmer BF, et al. Repeat revascularization after minimally invasive coronary artery bypass grafting: Is it a problem? Innovations (Phila), 2017, 12(4): 269-274.
21.	柳佳吉, 孔晴宇, 唐昭黎, 等. 微创冠状动脉旁路移植术学习曲线分析. 中国胸心血管外科临床杂志, 2021, 28(6): 639-644.

1. Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2019, 55(1): 4-90.
2. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
3. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
4. Ruel M, Shariff MA, Lapierre H, et al. Results of the minimally invasive coronary artery bypass grafting angiographic patency study. J Thorac Cardiovasc Surg, 2014, 147(1): 203-208.
5. Hannan EL, Wu Y, Cozzens K, et al. Hybrid coronary revascularization versus conventional coronary artery bypass surgery: Utilization and comparative outcomes. Circ Cardiovasc Interv, 2020, 13(10): e009386.
6. Kikuchi K, Mori M. Minimally invasive coronary artery bypass grafting: A systematic review. Asian Cardiovasc Thorac Ann, 2017, 25(5): 364-370.
7. Florisson DS, DeBono JA, Davies RA, et al. Does minimally invasive coronary artery bypass improve outcomes compared to off-pump coronary bypass via sternotomy in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg, 2018, 27(3): 357-364.
8. Kikuchi K, Une D, Suzuki K, et al. Off-pump minimally invasive coronary artery bypass grafting with a heart positioner: Direct retraction for a better exposure. Innovations (Phila), 2015, 10(3): 183-187.
9. Nakamura Y, Asaumi Y, Miyagi T, et al. Comparison of long-term mortality in patients with previous coronary artery bypass grafting who underwent percutaneous coronary intervention with versus without optimal medical therapy. Am J Cardiol, 2018, 122(2): 206-212.
10. Honda S, Asaumi Y, Yamane T, et al. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc, 2014, 3(5): e000984.
11. Ma X, Dong R, Chen P, et al. Percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting: A propensity score matching study. BMC Cardiovasc Disord, 2020, 20(1): 159.
12. Sakaguchi T, Totsugawa T, Tamura K, et al. Minimally invasive coronary artery bypass grafting: Useful routine option for coronary revascularization in selected cases. Gen Thorac Cardiovasc Surg, 2020, 68(10): 1128-1133.
13. Saha S, Varghese S, Herr M, et al. Minimally invasive versus conventional extracorporeal circulation circuits in patients undergoing coronary artery bypass surgery: A propensity-matched analysis. Perfusion, 2019, 34(7): 590-597.
14. Guan Z, Zhang Z, Gu K, et al. Minimally invasive CABG or hybrid coronary revascularization for multivessel coronary diseases: Which is best? A systematic review and meta analysis. Heart Surg Forum, 2019, 22(6): E493-E502.
15. Kikuchi K, Une D, Kurata A, et al. Off-pump minimally invasive coronary artery bypass grafting using the bilateral internal thoracic arteries and the right gastroepiproic artery. Eur J Cardiothorac Surg, 2016, 49(4): 1285-1286.
16. Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5): 1469-1477.
17. Sabashnikov A, Patil NP, Weymann A, et al. Outcomes after different non-sternotomy approaches to left single-vessel revascularization: A comparative study with up to 10-year follow-up. Eur J Cardiothorac Surg, 2014, 46(4): e48-e55.
18. Une D, Sakaguchi T. Initiation and modification of minimally invasive coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2019, 67(4): 349-354.
19. Kikuchi K, Une D, Endo Y, et al. Minimally invasive coronary artery bypass grating using bilateral in situ internal thoracic arteries. Ann Thorac Surg, 2015, 100(3): 1082-1084.
20. Rodriguez ML, Lapierre HR, Sohmer BF, et al. Repeat revascularization after minimally invasive coronary artery bypass grafting: Is it a problem? Innovations (Phila), 2017, 12(4): 269-274.
21. 柳佳吉, 孔晴宇, 唐昭黎, 等. 微创冠状动脉旁路移植术学习曲线分析. 中国胸心血管外科临床杂志, 2021, 28(6): 639-644.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical effects of minimally invasive versus conventional coronary artery bypass grafting for coronary heart disease: A retrospective cohort study

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