Clinical efficacy of minimally invasive coronary artery bypass grafting via left intercostal small incision for multivessel coronary artery disease: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Zeyuan , WANG Zhihua , WANG Sheng , CHEN Xianjie , LI Zhao , LU Guoqing , QI Zhenchang ,  CHENG Zhaoyun

Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 451464, P. R. China;

Corresponding author：

CHENG Zhaoyun, Email: Chengzhy@zzu.edu.cn

Keywords：

Coronary heart disease; minimally invasive surgery; off-pump coronary artery bypass grafting; multivessel coronary artery disease

DOI：

10.7507/1007-4848.202308061

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Objective To investigate the early clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) via left intercostal small incision for multivessel coronary artery disease. Methods The patients who received off-pump CABG in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group and a left intercostal small incision group. The clinical data of the two groups were compared. Results A total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left intercostal small incision group. The age of the patients in the left intercostal small incision group and the traditional midline sternotomy group was (63.8±8.0) years and (63.0±7.8) years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left intercostal small incision group were converted to thoracotomy. The patients in the left intercostal small incision group showed less postoperative drainage within postoperative 24 hours [(239.4±177.7) mL vs. (338.0±151.9) mL, P<0.001], lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay [(10.8±4.0) d vs. (13.1±5.3) d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. Conclusion Compared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.

Citation： ZHAO Zeyuan, WANG Zhihua, WANG Sheng, CHEN Xianjie, LI Zhao, LU Guoqing, QI Zhenchang, CHENG Zhaoyun. Clinical efficacy of minimally invasive coronary artery bypass grafting via left intercostal small incision for multivessel coronary artery disease: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(10): 1455-1461. doi: 10.7507/1007-4848.202308061 Copy

1.	Mack MJ, Squiers JJ, Lytle BW, et al. Myocardial revascularization surgery: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2021, 78(4): 365-383.
2.	Dimeling G, Bakaeen L, Khatri J, et al. CABG: when, why, and how? Cleve Clin J Med, 2021, 88(5): 295-303.
3.	Nambala S, Mishra YK, Ruel M. Less invasive multivessel coronary artery bypass grafting: now is the time. Curr Opin Cardiol, 2021, 36(6): 735-739.
4.	许志锋, 凌云鹏, 崔仲奇, 等. 经左胸前外侧微创冠脉搭桥治疗冠心病多支病变. 北京大学学报(医学版), 2020, 52(5): 863-869.Xu ZF, Ling YP, Cui ZQ, et al. 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. J Peking Univ (Health Sci), 2020, 52(5): 863-869.
5.	Van Praet KM, Kofler M, Shafti TZN, et al. Minimally invasive coronary revascularisation surgery: a focused review of the available literature. Interv Cardiol, 2021, 16: e08.
6.	Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
7.	Kikuchi K, Mori M. Minimally invasive coronary artery bypass grafting: a systematic review. Asian Cardiovasc Thorac Ann, 2017, 25(5): 364-370.
8.	Zhang LL, Xie ZL, Quan XQ, et al. Clinical efficacy evaluation of minimally invasive cardiac surgery coronary artery bypass grafting in patients with multivessel coronary artery disease. Zhonghua Yi Xue Za Zhi, 2022, 102(34): 2696-2701.
9.	Teman NR, Hawkins RB, Charles EJ, et al. Minimally invasive vs. open coronary surgery: a multi-institutional analysis of cost and outcomes. Ann Thorac Surg, 2021, 111(5): 1478-1484.
10.	Rajput NK, Kalangi TKV, Andappan A, et al. MICS CABG: a single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg, 2021, 37(1): 16-26.
11.	潘锋, 梁林, 肖巍, 等. 微创冠状动脉旁路移植术患者239例临床疗效的倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2023, 30(7): 976-981.Pan F, Liang L, Xiao W, et al. Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients:a propensity score matching study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(7): 976-981.
12.	傅元豪, 宫一宸, 张鲁锋, 等. 应用多支动脉桥经左胸小切口与正中切口行冠状动脉旁路移植术的临床效果比较. 中国微创外科杂志, 2023, 23(3): 208-215.Fu YH, Gong YC, Zhang LF, et al. Comparison of clinical effects between left chest small incision and median incision multi-arterial coronary artery bypass grafting. Chin J Minim Invasive Surg, 2023, 23(3): 208-215.
13.	Hage A, Hage F, Al-Amodi H, et al. Minimally invasive versus sternotomy for mitral surgery in the elderly: a systematic review and meta-analysis. Innovations (Phila), 2021, 16(4): 310-316.
14.	Brindle M, Nelson G, Lobo DN, et al. Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines. BJS Open, 2020, 4(1): 157-163.
15.	Liang L, Ma X, Kong Q, et al. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a single-center retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(3): 378-388.
16.	Patil S, Cornett EM, Jesunathadas J, et al. Implementing enhanced recovery pathways to improve surgical outcomes. J Anaesthesiol Clin Pharmacol, 2019, 35(Suppl 1): S24-S28.
17.	Kilger E, Pichler B, Weis F, et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Surg, 2000, 70(6): 2023-2028.
18.	Elghoneimy YA, Al Qahtani A, Almontasheri SA, et al. Renal impairment after cardiac surgery: risk factors, outcome and cost effectiveness. Cureus, 2020, 12(11): e11694.
19.	Claessens J, Yilmaz A, Awouters C, et al. Clinical results after hybrid coronary revascularization with totally endoscopic coronary surgery. J Cardiothorac Surg, 2022, 17(1): 98.
20.	Kang SH, Ahn JM, Lee CH, et al. Differential event rates and independent predictors of long-term major cardiovascular events and death in 5795 patients with unprotected left main coronary artery disease treated with stents, bypass surgery, or medication: Insights from a large international multicenter registry. Circ Cardiovasc Interv, 2017, 10(7): e004988.

1. Mack MJ, Squiers JJ, Lytle BW, et al. Myocardial revascularization surgery: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2021, 78(4): 365-383.
2. Dimeling G, Bakaeen L, Khatri J, et al. CABG: when, why, and how? Cleve Clin J Med, 2021, 88(5): 295-303.
3. Nambala S, Mishra YK, Ruel M. Less invasive multivessel coronary artery bypass grafting: now is the time. Curr Opin Cardiol, 2021, 36(6): 735-739.
4. 许志锋, 凌云鹏, 崔仲奇, 等. 经左胸前外侧微创冠脉搭桥治疗冠心病多支病变. 北京大学学报(医学版), 2020, 52(5): 863-869.Xu ZF, Ling YP, Cui ZQ, et al. 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. J Peking Univ (Health Sci), 2020, 52(5): 863-869.
5. Van Praet KM, Kofler M, Shafti TZN, et al. Minimally invasive coronary revascularisation surgery: a focused review of the available literature. Interv Cardiol, 2021, 16: e08.
6. Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
7. Kikuchi K, Mori M. Minimally invasive coronary artery bypass grafting: a systematic review. Asian Cardiovasc Thorac Ann, 2017, 25(5): 364-370.
8. Zhang LL, Xie ZL, Quan XQ, et al. Clinical efficacy evaluation of minimally invasive cardiac surgery coronary artery bypass grafting in patients with multivessel coronary artery disease. Zhonghua Yi Xue Za Zhi, 2022, 102(34): 2696-2701.
9. Teman NR, Hawkins RB, Charles EJ, et al. Minimally invasive vs. open coronary surgery: a multi-institutional analysis of cost and outcomes. Ann Thorac Surg, 2021, 111(5): 1478-1484.
10. Rajput NK, Kalangi TKV, Andappan A, et al. MICS CABG: a single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg, 2021, 37(1): 16-26.
11. 潘锋, 梁林, 肖巍, 等. 微创冠状动脉旁路移植术患者239例临床疗效的倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2023, 30(7): 976-981.Pan F, Liang L, Xiao W, et al. Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients:a propensity score matching study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(7): 976-981.
12. 傅元豪, 宫一宸, 张鲁锋, 等. 应用多支动脉桥经左胸小切口与正中切口行冠状动脉旁路移植术的临床效果比较. 中国微创外科杂志, 2023, 23(3): 208-215.Fu YH, Gong YC, Zhang LF, et al. Comparison of clinical effects between left chest small incision and median incision multi-arterial coronary artery bypass grafting. Chin J Minim Invasive Surg, 2023, 23(3): 208-215.
13. Hage A, Hage F, Al-Amodi H, et al. Minimally invasive versus sternotomy for mitral surgery in the elderly: a systematic review and meta-analysis. Innovations (Phila), 2021, 16(4): 310-316.
14. Brindle M, Nelson G, Lobo DN, et al. Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines. BJS Open, 2020, 4(1): 157-163.
15. Liang L, Ma X, Kong Q, et al. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a single-center retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(3): 378-388.
16. Patil S, Cornett EM, Jesunathadas J, et al. Implementing enhanced recovery pathways to improve surgical outcomes. J Anaesthesiol Clin Pharmacol, 2019, 35(Suppl 1): S24-S28.
17. Kilger E, Pichler B, Weis F, et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Surg, 2000, 70(6): 2023-2028.
18. Elghoneimy YA, Al Qahtani A, Almontasheri SA, et al. Renal impairment after cardiac surgery: risk factors, outcome and cost effectiveness. Cureus, 2020, 12(11): e11694.
19. Claessens J, Yilmaz A, Awouters C, et al. Clinical results after hybrid coronary revascularization with totally endoscopic coronary surgery. J Cardiothorac Surg, 2022, 17(1): 98.
20. Kang SH, Ahn JM, Lee CH, et al. Differential event rates and independent predictors of long-term major cardiovascular events and death in 5795 patients with unprotected left main coronary artery disease treated with stents, bypass surgery, or medication: Insights from a large international multicenter registry. Circ Cardiovasc Interv, 2017, 10(7): e004988.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of minimally invasive coronary artery bypass grafting via left intercostal small incision for multivessel coronary artery disease: A retrospective cohort study

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