Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Ann Surg. 2023 May 1;277(5):e1176-e1183. doi: 10.1097/SLA.0000000000005511. Epub 2022 Jul 7.
We aimed to describe the safety and clinical benefits of minimally invasive, nonsternotomy coronary artery bypass grafting (MICABG) using data from The Society of Thoracic Surgeons (STS) National Database.
MICABG has gained popularity, owing to expected lower perioperative morbidity and shorter recovery. Despite this, concerns remain regarding anastomotic quality and the validity of proposed perioperative benefits.
We queried the STS National Database for all patients who underwent single-vessel coronary artery bypass grafting (CABG) from January 2014 to December 2016 to compare outcomes of MICABG with conventional CABG. Patients who underwent concomitant or emergent procedures were excluded. Propensity-weighted cohorts were compared by operative approach with adjustment for variability across institutions.
Of 12,406 eligible patients, 2688 (21.7%) underwent MICABG, and 9818 (78.3%) underwent conventional CABG. Propensity weighting produced excellent balance in patient characteristics, including completeness of revascularization, body mass index, and STS predictive risk scores. MICABG was associated with significant reduction of in-hospital mortality [odds ratio (OR)=0.32, absolute reduction (AR)=0.91%, P <0.0001]; 30-day mortality (OR=0.51, AR=0.88%, P =0.001), duration of ventilation (8.62 vs 12.6 hours, P <0.0001), prolonged hospitalization (OR=0.77, AR=1.6, P =0.043), deep wound infection (OR=0.33, AR=0.68, P <0.004), postoperative transfusions (OR=0.52, AR=7.7%, P <0.0001), and STS composite morbidity (OR=0.72, AR=1.19%, P =0.008). Subgroup analysis of only off-pump left internal mammary artery-left anterior descending CABG showed similar findings. Major adverse cardiac events and graft occlusion did not differ between groups.
MICABG is associated with lower mortality and perioperative morbidity compared with conventional sternotomy CABG. MICABG may have a role in treating single-vessel disease.
我们旨在利用胸外科医师学会（STS）国家数据库的数据，描述微创非体外循环冠状动脉旁路移植术（MICABG）的安全性和临床获益。
由于 MICABG 预期具有较低的围手术期发病率和较短的恢复时间，因此它越来越受欢迎。尽管如此，对于吻合口质量和所提议的围手术期获益的有效性，仍存在一些担忧。
我们从 2014 年 1 月至 2016 年 12 月，在 STS 国家数据库中查询了所有接受单支冠状动脉旁路移植术（CABG）的患者，以比较 MICABG 与传统 CABG 的结果。排除同时进行或紧急进行的手术的患者。通过手术方法比较倾向评分加权队列，并对机构间的变异性进行调整。
在 12406 名合格患者中，2688 名（21.7%）接受了 MICABG，9818 名（78.3%）接受了传统 CABG。倾向评分加权在患者特征方面产生了极好的平衡，包括血运重建的完整性、体重指数和 STS 预测风险评分。与传统 CABG 相比，MICABG 显著降低了住院死亡率[比值比（OR）=0.32，绝对降低（AR）=0.91%，P<0.0001]；30 天死亡率（OR=0.51，AR=0.88%，P=0.001）、机械通气时间（8.62 与 12.6 小时，P<0.0001）、住院时间延长（OR=0.77，AR=1.6，P=0.043）、深部伤口感染（OR=0.33，AR=0.68，P<0.004）、术后输血（OR=0.52，AR=7.7%，P<0.0001）和 STS 综合发病率（OR=0.72，AR=1.19%，P=0.008）。仅体外循环左乳内动脉-前降支 CABG 的亚组分析显示出类似的结果。两组之间主要不良心脏事件和移植物闭塞无差异。
与传统的胸骨切开术 CABG 相比，MICABG 具有更低的死亡率和围手术期发病率。MICABG 可能在治疗单支血管疾病方面发挥作用。
