Safety and effectiveness of minimally invasive coronary artery bypass grafting in 143 patients: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Lin , KONG Qingyu , LIU Jiaji , XIAO wei , CHEN Xinliang , MA Xiaolong , HUANG Yu , PAN Feng , GENG Danqing ,  CHI Liqun

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, P.R.China;

Corresponding author：

CHI Liqun, Email: chiliqun2002@qq.com

Keywords：

Minimal invasive; coronary artery bypass grafting; propensity-score matching; surgery

DOI：

10.7507/1007-4848.202011002

Video：

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Objective To investigate the safety and effectiveness of minimally invasive coronary artery bypass grafting (MICABG) through comparing the perioperative clinical effects of conventional surgery and MICABG.Methods A total of 543 patients in the single medical group of Beijing Anzhen Hospital who underwent beating coronary artery bypass grafting from January 2017 to September 2020 were collected, including 161 patients receiving MICABG (a minimally invasive group, 143 males and 18 females, aged 60.08±9.21 years), 382 patients receiving median thoracotomy (a conventional group, 284 males and 98 females, aged 61.68±8.81 years). The propensity score was used to match 143 patients in each of the two groups, and the perioperative data of the two groups were summarized and analyzed.Results There was no death, perioperative myocardial infarction or stroke in the minimally invasive group. Compared with the conventional group, the minimally invasive group had longer operation time (296.36±89.4 min vs. 217.80±50.63 min, P=0.000), less number of bypass grafts (2.86±1.03 vs. 3.17±0.78, P=0.005), shorter postoperative hospital stay (6.29±1.46 d vs. 6.78±2.61 d, P=0.031), less drainage on postoperative day 1 (339.57±180.63 mL vs. 441.92±262.63 mL, P=0.001) and lower usage rate of inotropic drugs (9.09% vs. 26.57%, P=0.001). There was no statistical difference between the two groups in postoperative ICU stay ventilator assistance time, blood transfusion rate, secondary thoracotomy rate, or use of mechanical equipment.Conclusion Reasonable clinical strategies can ensure the satisfactory overall safety of MICABG. In addition, it has the advantages of shorter postoperative hospital stay, less bleeding and smaller dosage of inotropic drugs.

Citation： LIANG Lin, KONG Qingyu, LIU Jiaji, XIAO wei, CHEN Xinliang, MA Xiaolong, HUANG Yu, PAN Feng, GENG Danqing, CHI Liqun. Safety and effectiveness of minimally invasive coronary artery bypass grafting in 143 patients: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(2): 169-173. doi: 10.7507/1007-4848.202011002 Copy

1.	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.
2.	Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5): 1469-1477.
3.	Boodhwani M, Ruel M, Mesana TG, et al. Minimally invasive direct coronary artery bypass for the treatment of isolated disease of the left anterior descending coronary artery. Can J Surg, 2005, 48(4): 307-310.
4.	Puskas JD, Halkos ME, DeRose JJ, et al. Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: A multicenter observational study. J Am Coll Cardiol, 2016, 68(4): 356-365.
5.	Srivastava SP, Patel KN, Skantharaja R, et al. Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases. Ann Thorac Surg, 2003, 76(1): 46-49.
6.	McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
7.	柳佳吉, 迟立群, 孔晴宇, 等. 肋间单一切口直视下微创多支 OPCABG 50 例. 中华胸心血管外科杂志, 2019, 35(3): 159-162.
8.	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.
9.	Rodriguez ML, Lapierre HR, Sohmer B, et al. Predictors and outcomes of sternotomy conversion and cardiopulmonary bypass assistance in minimally invasive coronary artery bypass grafting. Innovations (Phila), 2016, 11(5): 315-320.
10.	Barsoum EA, Azab B, Shah N, et al. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg, 2015, 47(5): 862-867.
11.	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.
12.	Takami Y, Tajima K, Kato W, et al. Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2014, 147(1): 259-263.
13.	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. 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.
2. Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5): 1469-1477.
3. Boodhwani M, Ruel M, Mesana TG, et al. Minimally invasive direct coronary artery bypass for the treatment of isolated disease of the left anterior descending coronary artery. Can J Surg, 2005, 48(4): 307-310.
4. Puskas JD, Halkos ME, DeRose JJ, et al. Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: A multicenter observational study. J Am Coll Cardiol, 2016, 68(4): 356-365.
5. Srivastava SP, Patel KN, Skantharaja R, et al. Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases. Ann Thorac Surg, 2003, 76(1): 46-49.
6. McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
7. 柳佳吉, 迟立群, 孔晴宇, 等. 肋间单一切口直视下微创多支 OPCABG 50 例. 中华胸心血管外科杂志, 2019, 35(3): 159-162.
8. 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.
9. Rodriguez ML, Lapierre HR, Sohmer B, et al. Predictors and outcomes of sternotomy conversion and cardiopulmonary bypass assistance in minimally invasive coronary artery bypass grafting. Innovations (Phila), 2016, 11(5): 315-320.
10. Barsoum EA, Azab B, Shah N, et al. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg, 2015, 47(5): 862-867.
11. 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.
12. Takami Y, Tajima K, Kato W, et al. Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2014, 147(1): 259-263.
13. 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.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and effectiveness of minimally invasive coronary artery bypass grafting in 143 patients: A propensity-score matching study

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