Very Long-term Outcome of Minimally Invasive Direct Coronary Artery Bypass

Abstract

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Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting

“…Patients in the MIDCAB group had less blood transfusion, lower postoperative Troponin peak values, and shorter time on ventilator, and lower need for surgical revisions than the FS-OPCAB group. These findings are consistent with other studies (18,19). Notably, in our series there was no perioperative mortality in the MIDCAB group.…”

“…The MIDCAB group experienced fewer in-hospital stays, required fewer blood transfusions, and had a reduced incidence of cardiac-related events than their counterparts in the full sternotomy group. However, the reported results were not adjusted to baseline covariates ( 18 ).…”

Commentary: Sometimes less is more. Should minimally invasive direct coronary artery bypass become the new standard for revascularization of the left anterior descending artery?

“…This study has the largest MIDCAB experience in the literature with a 20-year follow-up. [2][3][4][5][6] The survival results are similar not only to those reported in other MIDCAB studies, 5,6 but also to those reported for conventional coronary artery bypass via sternotomy and cardiopulmonary bypass. 7 Also encouraging was the lower revascularization rate for MIDCAB compared with PCI for proximal LAD disease (5.5% vs 20%-34%).…”

¿Podrían los procedimientos quirúrgicos de revascularización mínimamente invasivos convertirse en el estándar de oro para la cardiopatía isquémica?

“…Thence, MIDCAB is considered a powerful option for the treatment of single-vessel coronary disease. 18 Recently published American guideline on ischemic heart disease recommended 2a PCI for the treatment of LAD or left main (LM) coronary artery disease, at which point MIDCAB may be beneficial for long-term survival and repeated revascularization. 19 The meta-analysis from Gianoli et al comparing MIDCAB and PCI revealed that PCI had a lower in-hospital mortality rate, whereas MIDCAB demonstrated superiority in terms of long-term survival and repeated revascularization.…”