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Abstract：
OBJECTIVE: Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases.
METHODS: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints.
RESULTS: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4).
CONCLUSIONS: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.
METHODS: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints.
RESULTS: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4).
CONCLUSIONS: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.
摘要：
目的：经胸外侧切开术的微创冠状动脉手术（MICS）是传统正中全胸骨切开术冠状动脉手术的一种微创替代方法。这项研究调查了其在单血管和多血管疾病病例中短期和长期血运重建的有效性。
方法：对两个心脏手术项目的数据库进行了彻底的检查，重点关注2010年至2023年间接受微创冠状动脉旁路移植术的患者.该研究涉及接受微创直接冠状动脉旁路移植术（MIDCAB）的左前降支（LAD）动脉狭窄血运重建或微创多支冠状动脉旁路移植术（MICSCABG）的患者。我们的评估标准包括住院死亡率，长期死亡率，以及术后由于主动脉冠状动脉旁路移植术失败而免于再次手术。此外,我们评估了显著的院内并发症作为次要终点.
结果：在2010年至2023年之间共确定了315例连续患者（MIDCAB271与MICSCABG44).八名患者（2.5％）转换为正中胸骨切开术（MS）。30天全因死亡率为1.3%(n=4)。术后房颤是术后最常见的并发症（n=26，8.5％）。5例患者因出血再次手术(1.6%),4例（1.3％）发生心肌梗死（MI）。平均随访时间为6年（±4年）。全因死亡率为10.3％（n=30），只有五名(1.7%)患者有明确的心脏原因。移植失败或主动脉冠状动脉疾病进展导致的再手术率为1.4％（n=4）。
结论：尽管MICS方法很复杂，我们的研究结果支持该手术的安全性和有效性，死亡率低，发病率，以及单血管和多血管旁路手术的转换。这些结果进一步强调了实施此类计划以使患者受益的必要性。
方法：对两个心脏手术项目的数据库进行了彻底的检查，重点关注2010年至2023年间接受微创冠状动脉旁路移植术的患者.该研究涉及接受微创直接冠状动脉旁路移植术（MIDCAB）的左前降支（LAD）动脉狭窄血运重建或微创多支冠状动脉旁路移植术（MICSCABG）的患者。我们的评估标准包括住院死亡率，长期死亡率，以及术后由于主动脉冠状动脉旁路移植术失败而免于再次手术。此外,我们评估了显著的院内并发症作为次要终点.
结果：在2010年至2023年之间共确定了315例连续患者（MIDCAB271与MICSCABG44).八名患者（2.5％）转换为正中胸骨切开术（MS）。30天全因死亡率为1.3%(n=4)。术后房颤是术后最常见的并发症（n=26，8.5％）。5例患者因出血再次手术(1.6%),4例（1.3％）发生心肌梗死（MI）。平均随访时间为6年（±4年）。全因死亡率为10.3％（n=30），只有五名(1.7%)患者有明确的心脏原因。移植失败或主动脉冠状动脉疾病进展导致的再手术率为1.4％（n=4）。
结论：尽管MICS方法很复杂，我们的研究结果支持该手术的安全性和有效性，死亡率低，发病率，以及单血管和多血管旁路手术的转换。这些结果进一步强调了实施此类计划以使患者受益的必要性。
