Abstract
OBJECTIVE: This study evaluated the safety and feasibility of minimally invasive coronary surgery (MICS) for patients with multivessel disease. METHODS: Patients with multivessel coronary artery disease (CAD) undergoing isolated off-pump coronary artery bypass grafting surgery (OPCAB) in our center between January 2017 and December 2020 were included in this study. Patients were divided into the MICS group or the conventional OPCAB group. Clinical characteristics, surgical data, postoperative outcomes and graft patency were analyzed between the two groups. Propensity score matching (PSM) was performed to reduce the potential effects of a selection bias. RESULTS: A total of 476 patients were included in this study, with 103 patients in the MICS group and 373 patients in the OPCAB group. Before matching, patients in the MICS group showed a higher left ventricular ejection fraction (LVEF) and a lower left ventricular end-diastolic dimension (LVEDD), and the proportion of patients with 3 target vessels or more was significantly lower in the MICS group. Following the PSM, bilateral internal thoracic arteries (ITAs), sequential grafting and composite conduits were more frequently used in the MICS group, and the proportion of patients with 2 anastomoses or more on the ascending aorta was significantly lower in the MICS group. The postoperative length of stay was significantly shorter in the MICS group, and the rate of wound dehiscence was lower in the MICS group. There was no difference in the rate of postoperative MI, stroke, repeated revascularization, or in-hospital death between the two groups. The short-term graft patency was similar between the two groups. CONCLUSIONS: MICS can achieve comparable clinical outcomes and graft patency to conventional OPCAB. Cardiac function and the number of target vessels are two factors that surgeons take in consideration when deciding to proceed with a MICS. Sequential grafts and composite conduits are more frequently used in MICS patients, which is in accordance with the reduction in the number of proximal anastomoses performed on the ascending aorta.