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.

No conflict of interest has been declared by the author(s).