Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease - A propensity matched analysis

Fleur Sampon; Joost Ter Woorst; Lukas Dekker; Ferdi Akca

doi:10.1016/j.ijcard.2024.132175

Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease - A propensity matched analysis

Int J Cardiol. 2024 May 14:409:132175. doi: 10.1016/j.ijcard.2024.132175. Online ahead of print.

Authors

Fleur Sampon¹, Joost Ter Woorst¹, Lukas Dekker², Ferdi Akca³

Affiliations

¹ Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
² Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Departments of Biomedical Technology, Eindhoven University of Technology, the Netherlands.
³ Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands. Electronic address: ferdi.akca@catharinaziekenhuis.nl.

PMID: 38754586
DOI: 10.1016/j.ijcard.2024.132175

Abstract

Objective: This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease.

Methods: In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. 'Textbook outcome' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome.

Results: Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001).

Conclusions: Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.

Keywords: Coronary surgery; Endo-CAB; Minimally invasive; Off-pump; Textbook outcome; Thoracoscopic LIMA harvesting.