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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (5): 863-869. doi: 10.19723/j.issn.1671-167X.2020.05.011

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Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results

Zhi-feng XU1,2,Yun-peng LING2,∆(),Zhong-qi CUI2,hong ZHAO2,Yi-chen GONG2,Yuan-hao FU2,Hang YANG2,Feng WAN2   

  1. 1. Department of Cardiac Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
    2. Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2018-03-07 Online:2020-10-18 Published:2020-10-15
  • Contact: Yun-peng LING E-mail:micsling@163.com

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Abstract:

Objective: To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. Methods: Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). Results: There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P<0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P<0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. Conclusion: The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

Key words: Minimally invasive cardiac surgery, Minimally invasive, Off-pump coronary aortic bypass grafting, Multiple coronary artery lesions, Clinical effect

CLC Number: 

  • R654

Figure 1

Minimally invasive cardiac coronary artery bypass grafting surgery (MICS CABG) via left minithoracotomy A,internal thoracic artery (IMAs) exposed, the LIMA could be well exposed by using a new type of internal mammary artery traction system (a) used to pull the chest wall forward from the upper edge of the incision with a small incision rib retractor, and the RIMA could be exposed by pulling the chest wall from the xiphoid process through the Rutract traction device (b) and cooperating with the suspension type internal mammary artery traction system; B, double internal artery (DIMAs) bypass, RIMA end to side anastomosed in the middle of LIMA forming a “LIMA-Y-RIMA” composite bridge, left anterior descending coronarg artery (LAD) and OM were anastomosised in the end of the composite bridge respectively; C, LAD anastomosis, LAD bypassed through small incision by LIMA; D, posterior descending artery (PDA) anastomosis, PDA exposured by appling of endoscopic cardiac stabilizer and bypassed with SVG. "

Table 1

Clinical characteristics after match"

Items MICS CABG (n=85) OPCABG (n=85) t/χ2 value P value
General characteristics
Age/years, x-±s 63.8±8.7 63.1±13.2 0.408 0.684
Male, n(%) 68 (80.0) 66 (77.6) 0.141 0.707
BMI/(kg/m2), x-±s 25.5±2.7 25.1±3.3 0.865 0.388
Coronary artery and cardiac function
Coronary artery lesions≥3, n(%) 52 (61.2) 54 (63.3) 0.100 0.752
History of PCI, n(%) 29 (34.1) 21 (24.7) 1.813 0.178
LVDd/mm, x-±s 48.4±8.4 47.9±9.8 0.357 0.772
EF/%, x-±s 52.2±5.7 53.3±8.5 -0.991 0.323
Cardiac-related complications
HBP, n(%) 50 (58.8) 52 (61.2) 0.098 0.754
History of myocardial infarction, n(%) 17 (20.0) 21 (24.7) 0.542 0.461
Congestive heart failure, n(%) 2 (2.3) 1 (1.2) 0.339 1.000
Non-cardiac-related complications
Hypercholesterolemia, n(%) 12 (14.1) 11 (14.0) 0.050 0.823
Diabetes, n(%) 25 (29.4) 33 (38.9) 1.675 0.196
Chronic lung disease, n(%) 0 (0.0) 5 (5.9) 5.152 0.059
History of cerebrovascular disease, n(%) 5 (5.8) 3 (3.8) 0.525 0.720
Peripheral vascular disease, n(%) 1 (1.2) 2 (2.3) 0.330 1.000
Creatinine /(μmol/L), x-±s 66.7±15.2 72.5±22.5 -1.969 0.051

Table 2

Perioperative conditions in MICS CABG group and OPCABG group"

Items MICS CABG (n=85) OPCABG (n=85) t/χ2 value P value
Ventilator supporting time after operation/h,(x-±s) 16.9±7.8 29.6±15.9 -6.611 <0.001
Hospitalization in ICU/h,(x-±s) 29.3±20.8 51.5±48.3 -3.892 <0.001
Total hospitalization/d,(x-±s) 18.3±3.2 25.7±4.2 -12.921 <0.001
Blood transfusion during operation, n(%) 26 (30.5) 30 (35.2) 0.426 0.514
IABP during operation, n(%) 1 (1.17) 2 (2.35) 0.330 1.000
Impaired wound healing, n(%) 0 (0) 1 (1.17) 1.006 1.000
Re-exploration for hemorrhage, n(%) 2 (2.34) 3 (3.52) 0.206 1.000
New-onset atrial fibrillation after operation, n(%) 4 (4.70) 3 (3.52) 0.149 1.000
New-onset renal insufficiency after operation, n(%) 1 (1.17) 0 (0.00) 1.006 1.000
MACCE, n(%) 1 (1.17) 2 (2.35) 0.330 1.000
Death, n(%) 0 (0) 1 (1.17) 1.006 1.000
Perioperative myocardial infarction, n(%) 1 (1.17) 1 (1.17) 0.000 1.000
Cerebrovascular complications, n(%) 0 (0) 0 (0) - -
Revascularization, n(%) 0 (0) 0 (0) - -

Table 3

The patency of coronary angiography anastomosis in MICS CABG group n(%)"

Bypass grafts n O B A A+B
LAD 85 1 (1.18) 2 (2.35) 82 (96.5) 84 (98.8)
D 26 1 (3.85) 0 (0.00) 25 (96.2) 25 (96.2)
RAMUS 4 0 (0.00) 0 (0.00) 4 (100.0) 4 (100.0)
OM, LCX 56 1 (1.79) 4 (7.14) 51 (91.1) 55 (98.2)
PL, PDA 29 4 (13.79) 0 (0.00) 25 (86.2) 25 (86.2)
Total 200 7 (3.50) 6 (3.0) 187 (93.5) 193 (96.5)

Figure 2

Kaplan-Meier survival curve of major adverse cardiacand cerebrovascular events (MACCE) accumulation rate in two groups Log rank χ2=0.234, P=0.628. MICS CABG, minimally invasive cardiac surgery coronary artery bypass grafting; OPCABG, off-pump coronary aortic bypass grafting. "

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