Minimally invasive direct coronary artery bypass versus single internal thoracic artery grafting procedures for multivessel coronary artery disease: a single-center retrospective analysis

Objective: To compare two surgical strategies for myocardial revascularization: one by a minimally invasive direct coronary artery bypass (MIDCAB) and the other by a conventional full sternotomy coronary artery bypass grafting (CABG). Methods: We reviewed the early outcomes and overall survival of all the patients treated in our center by the above strategies during 2000–2011. Results: Of 1915 patients, 1752 underwent conventional CABG utilizing a single internal thoracic artery (ITA) graft and 163 underwent a MIDCAB procedure. In the former compared to the latter, the patients were older and the median EuroSCORE was higher. The prevalences were higher of diabetes mellitus, recent myocardial infarction, emergency procedures, the.usage of an intra-aortic balloon pump, redo operations, and peripheral vascular disease; and the prevalences lower of chronic obstructive pulmonary disease and chronic renal failure. The median follow-up was 20 years. Early mortality (30 day) was greater in the conventional CABG group (3.6% vs. 0.6%, p = 0.042); and 10-, 15- and 20-year survival rates were lower: 55.1% vs. 76.7%, 37.1% vs. 63.7%, and 23.1% vs. 53.4%, respectively, p < 0.001. In an analysis that compared two matched groups of 134 patients each, early outcomes were similar, but late survival was lower following conventional CABG compared to MIDCAB after 10, 15 and 20 years: 64.7% vs. 74.6%, 44.7% vs. 64.1%, and 28.4% vs. 53.6% respectively, p = 0.004. In multivariable and univariate analysis, MIDCAB strategy compared to conventional single ITA CABG was associated with better late survival; the hazard ratio was 0.429 (95%CI 0.321–0.574, p < 0.001) for the whole cohort and 0.559 (95%CI: 0.376–0.831, p = 0.004), for the matched cohort. Conclusions: Compared to conventional CABG utilizing a single ITA, the MIDCAB procedure demonstrated early safety and long-term effectiveness for surgical myocardial revascularization of the left anterior descending artery.