Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease

A Systematic Review

Sef, Davorin MD, PhD, MEBCTS
Thet, Myat Soe MD, MSc
Hashim, Shahrul Amry MBBS, FRCS(C-Th)
Kikuchi, Keita MD, PhD

¹Department of Cardiac Surgery, University Hospitals of Leicester, UK
²Department of Surgery and Cancer, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, UK
³Department of Cardiothoracic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
⁴Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan

Davorin Sef, MD, PhD, MEBCTS, Department of Cardiac Surgery, University Hospitals of Leicester, Hill End Road, Leicester, LE3 9QP, UK. Email: [email protected]

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 19(4):p 351-359, July/August 2024. | DOI: 10.1177/15569845241265867

Objective:

We conducted a systematic review of all available evidence on the feasibility and safety of minimally invasive coronary artery bypass grafting (MICS CABG) in patients with multivessel coronary artery disease (CAD).

Methods:

A systematic literature search in PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science was performed to identify all relevant studies evaluating outcomes of MICS CABG among patients with multivessel CAD and including at least 15 patients with no restriction on the publication date.

Results:

A total of 881 studies were identified, of which 26 studies met the eligibility criteria. The studies included a total of 7,556 patients. The average patient age was 63.3 years (range 49.5 to 69.0 years), male patients were an average of 77.8% (54.0% to 89.8%), and body mass index was 29.8 kg/m² (24.5 to 30.1 kg/m²). Early mortality and stroke were on average 0.6% (range 0% to 2.0%) and 0.4% (range 0% to 1.3%), respectively. The average number of grafts was 2.8 (range 2.1 to 3.7). The average length of hospital stay was 5.6 days (range 3.1 to 9.3 days).

Conclusions:

MICS CABG appears to be a safe method in well-selected patients with multivessel CAD. This approach is concentrated at dedicated centers, and there is no widespread application, although it has potential to be widely applicable as an alternative for surgical revascularization. However, large randomized controlled studies with longer follow-up are still required to compare the outcomes with conventional CABG and other revascularization strategies.