Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Feng , LIANG Lin , XIAO Wei , LIU Jiaji , MA Xiaolong , GENG Danqing , ZHAO Guangxin ,  CHI Liqun ,  KONG Qingyu

Department of Minimally Invasive Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding?author：

CHI Liqun, Email: chiliqun2002@qq.com; KONG Qingyu, Email: kongqingyu@126.com

Keywords：

Minimal invasiveness; coronary artery bypass grafting; propensity score matching; follow-up

DOI：

10.7507/1007-4848.202205031

Video：

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Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P＞0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P＞0.05). Conclusion Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.

Citation： PAN Feng, LIANG Lin, XIAO Wei, LIU Jiaji, MA Xiaolong, GENG Danqing, ZHAO Guangxin, CHI Liqun, KONG Qingyu. Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 976-981. doi: 10.7507/1007-4848.202205031 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.	Andrawes PA, Shariff MA, Nabagiez JP, et al. Evolution of minimally invasive coronary artery bypass grafting: Learning curve. Innovations (Phila), 2018, 13(2): 81-90.
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.	柳佳吉, 遲立群, 孔晴宇, 等. 肋間單一切口直視下微創多支OPCABG 50例. 中華胸心血管外科雜志, 2019, 35(3): 159-162.
12.	Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
13.	Snegirev MA, Paivin AA, Denisyuk DO, et al. Minimally invasive multivessel coronary bypass surgery: Angiographic patency data. J Card Surg, 2020, 35(3): 620-625.
14.	Une D, Sakaguchi T. Initiation and modification of minimally invasive coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2019, 67(4): 349-354.
15.	Rodriguez ML, Lapierre HR, Sohmer B, et al. Mid-term follow-up of minimally invasive multivessel coronary artery bypass grafting: Is the early learning phase detrimental? Innovations (Phila), 2017, 12(2): 116-120.
16.	柳佳吉, 孔晴宇, 唐昭黎, 等. 微創冠狀動脈旁路移植術學習曲線分析. 中國胸心血管外科臨床雜志, 2021, 28(6): 639-644.
17.	Bergsland J, Lingaas PS, Skulstad H, et al. Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery. Ann Thorac Surg, 2009, 87(1): 54-60.
18.	Tokuda Y, Song MH, Ueda Y, et al. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2007, 84(6): 1928-1933.

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. Andrawes PA, Shariff MA, Nabagiez JP, et al. Evolution of minimally invasive coronary artery bypass grafting: Learning curve. Innovations (Phila), 2018, 13(2): 81-90.
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. 柳佳吉, 遲立群, 孔晴宇, 等. 肋間單一切口直視下微創多支OPCABG 50例. 中華胸心血管外科雜志, 2019, 35(3): 159-162.
12. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
13. Snegirev MA, Paivin AA, Denisyuk DO, et al. Minimally invasive multivessel coronary bypass surgery: Angiographic patency data. J Card Surg, 2020, 35(3): 620-625.
14. Une D, Sakaguchi T. Initiation and modification of minimally invasive coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2019, 67(4): 349-354.
15. Rodriguez ML, Lapierre HR, Sohmer B, et al. Mid-term follow-up of minimally invasive multivessel coronary artery bypass grafting: Is the early learning phase detrimental? Innovations (Phila), 2017, 12(2): 116-120.
16. 柳佳吉, 孔晴宇, 唐昭黎, 等. 微創冠狀動脈旁路移植術學習曲線分析. 中國胸心血管外科臨床雜志, 2021, 28(6): 639-644.
17. Bergsland J, Lingaas PS, Skulstad H, et al. Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery. Ann Thorac Surg, 2009, 87(1): 54-60.
18. Tokuda Y, Song MH, Ueda Y, et al. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2007, 84(6): 1928-1933.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients: A propensity score matching study

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