Title : Comparison of minimally invasive and conventional coronary artery bypass grafting in patients older than 75 years
Abstract:
Objective: Coronary artery bypass grafting (CABG) via sternotomy is the standard and conventional procedure for patients with multivessel coronary artery disease. Minimally invasive coronary artery bypass grafting (MICS CABG) via left thoracotomy has become an alternative procedure because it can protect the integrity of the sternum and promote recovery. The technical difficulty of MICS CABG restricts its widespread implementation. This study aims to evaluate the clinical outcomes of elderly patients between the MICS CABG group and the conventional CABG group.
Methods: This observational study retrospectively collected patients older than 75 years who underwent CABG from Dec 1, 2019, to Aug 30, 2023. The whole cohort was further divided into the MICS CABG group or the conventional CABG group. The primary outcome was one-year mortality after surgery. Secondary outcomes included postoperative stroke, renal insufficiency, infection, atrial fibrillation, and length of hospital stay.
Results: A total of 285 patients were collected, including 156 patients in the conventional group and 129 cases in the MICS CABG group. The Kaplan-Meier curve showed that there was no significant difference in the one-year mortality between MICS CABG and the conventional CABG group. MICS CABG had a lower incidence of postoperative stroke than the conventional CABG (2.33% vs 8.33%, P = 0.03). Logistic regression analysis showed that MICS CABG was associated with a lower risk of postoperative stroke (OR = 0.26, 95% CI 0.07-0.94, p = 0.04) compared with the conventional CABG group. There appeared to be no differences in postoperative renal insufficiency, infection, and atrial fibrillation between both procedures (All p > 0.05). Besides, the length of hospital stay was shorter in the MICS CABG group as compared to the conventional CABG group (p = 0.02).
Conclusions: MICS CABG can bring a similar one-year survival rate and a lower incidence of stroke compared with the conventional CABG. MICS CABG is a safe and effective procedure for elder patients. Further studies are needed to compare the long-term outcomes of both approaches.
