MIDCAB /− PCI/DES versus OPCAB for Severe Coronary Artery Disease

Objectives: We hypothesized that MIDCAB (minimal invasive direct coronary bypass surgery) ± PCI/DES compared to classical “off pump” coronary artery bypass surgery (OPCAB) for the treatment of severe coronary artery disease is associated with reduced perioperative morbidity and mortality.

Methods: Preoperative and postoperative clinical data were collected prospectively on 271 consecutive patients with severe coronary artery disease undergoing either a MIDCAB procedure ± PCI/DES (MIDCAB group), n = 91 patients, or classical OPCAB (OPCAB group), n = 180 patients, at our institution from January 2017 to August 2018.

Results: Patient demographics were similar between both groups. All MIDCAB patients underwent a left-sided mini-thoracotomy and received a single LIMA-LAD graft, OPCAB patients received on average 2.7 coronary bypass grafts, p < 0.001. Maximum postoperative CK-MB levels were higher in OPCAB compared to MIDCAB patients, 27.1U/L vs. 9.0U/L, p = 0.02. Intubation time was shorter in MIDCAB compared to OPCAB patients, 7.8 h vs. 15.6 h, p = 0.02. ICU time was shorter in MIDCAB patients, 1.2 h vs. 1.7 h, p = 0.01. Chest tube drainage was higher in those with OPCAB compared to MIDCAB after 24 hours, 723 mL vs. 479 mL, p = 0.001. Transfusions of blood, platelets, and fresh frozen plasma were rarely needed; there was no difference between both groups. A transient neurological deficit developed in five (2.7%) patients in the OPCAB group and no such cases in the MIDCAB group, p = 0.2. A hybrid procedure, MIDCAB + PCI/DES, was performed in 24% (22 of 91 patients), and 4 (2.2%) patients in the OPCAB group underwent postoperative PCI/DES. In-hospital mortality was 0% in MIDCAB patients and 1.7% in the OPCAB group, p = 1.

Conclusions: MIDCAB ± PCI/DES for patients with severe coronary artery disease is a safe procedure and might be the better option than classical OPCAB. MIDCAB ± PCI/DES is not only less invasive but associated with reduced perioperative myocardial ischemia, shorter intubation and ICU time, reduced chest tube drainage, rarely needed transfusions and no neurological complications.