Objective To compare the safety and efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) and traditional CABG in patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods From 2019 to 2021, the patients who received CABG by the same medical group in the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital were retrospectively enrolled. According to the surgery methods, the patients were divided into two groups: a MICS CABG group and a conventional group. The perioperative and postoperative follow-up data of patients were collected. The main observation results included all cause death events, myocardial infarction, cerebrovascular, revascularization, and adverse wound healing. Results According to the inclusion and exclusion criteria, 140 patients were enrolled, including 66 patients in the MICS CABG group [56 males and 10 females, aged (61.83±8.94) years], and 74 patients in the conventional group [55 males and 19 females, aged (58.61±8.26) years]. Compared with the conventional group, patients in the MICS CABG group had longer median surgical time (4.50 h vs. 4.00 h, P=0.005), less intraoperative bleeding (600.00 mL vs. 700.00 mL, P=0.020), and a lower rate of secondary debridement and suturing of surgical wounds (4.5% vs. 16.2%, P=0.023). The median follow-up time was 2.54 years. There was no statistically significant difference in the cumulative incidence of major adverse cardiac and cerebrovascular events (7.6% vs. 5.4%), all-cause mortality (0.0% vs. 0.0%), myocardial infarction (3.0% vs. 2.7%), cerebrovascular events (4.5% vs. 2.7%), or revascularization (0.0% vs. 0.0%) between the two groups of patients during the postoperative follow-up (P>0.05). Conclusion MICS CABG can achieve the same revascularization effect as traditional CABG in patients with CHD and DM. MICS CABG can effectively reduce adverse clinical outcomes or complications such as adverse chest wound healing and slow postoperative recovery of body function in patients with DM.
Objective To compare the surgical outcomes between conventional coronary artery bypass grafting (CABG) and minimally invasive direct coronary artery bypass grafting via left small thoracotomy stratified by different levels of non-invasive fractional flow reserve computed tomography (FFR-CT), and to explore the recommended FFR-CT cut-off values for selecting appropriate coronary vessels for grafting in the two surgical procedures. MethodsA retrospective enrollment was conducted on patients who underwent isolated CABG at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital from 2022 to 2025, including conventional median sternotomy CABG and minimally invasive CABG. Clinical data comprising preoperative FFR-CT of target vessels, preoperative coronary angiography, intraoperative instantaneous flow of corresponding bypass grafts, peak postoperative troponin level, postoperative graft patency after discharge, and the incidence of major adverse cardiovascular and cerebrovascular event (MACCE) were collected. Patients were divided into two groups according to FFR-CT value: FFR-CT＞0.80 and FFR-CT≤0.80. Intraoperative graft flow was classified into three grades: Grade 1 (flow≤30 mL/min), Grade 2 (30 mL/min＜flow≤60 mL/min), and Grade 3 (flow＞60 mL/min). The differences in intraoperative flow corresponding to different FFR-CT levels were compared between patients undergoing conventional CABG and minimally invasive CABG respectively, and regression analyses were performed separately. Postoperative troponin was also graded into three levels: Grade 1 (troponin I＜2 000 ng/L), Grade 2 (2 000 ng/L≤troponin I＜5 000 ng/L), and Grade 3 (troponin I≥5 000 ng/L). Troponin I levels were compared between the two groups. ResultsA total of 390 patients with 928 target vessels were enrolled, including 207 patients undergoing conventional CABG (542 target vessels; 153 males and 54 females, aged 43-81 years) and 183 patients undergoing minimally invasive CABG (386 target vessels; 144 males and 39 females, aged 46-84 years). For conventional CABG, target vessels with FFR-CT≤0.80 presented better intraoperative graft flow. The regression equation was Q (flow grade)=–3.077FFR3+3.455. FFR-CT＜0.78 was recommended to achieve optimal intraoperative graft flow. For minimally invasive CABG, superior intraoperative graft flow was also observed in target vessels with FFR-CT≤0.80, with the regression equation Q (flow grade)=–24.560FFR2+30.207FFR–6.492, and the recommended cut-off value was FFR-CT＜0.80. For coronary arteries with angiographically moderate stenosis, intraoperative graft flow differed significantly among different FFR-CT subgroups (P＜0.001), with higher flow in the FFR-CT≤0.80 group. Moreover, lower FFR-CT value of target vessels was associated with lower peak postoperative troponin I level. ConclusionFFR-CT serves as a reliable reference indicator for target vessel selection in conventional CABG and left small thoracotomy minimally invasive CABG, especially for coronary lesions with angiographically moderate stenosis. In addition, FFR-CT has certain predictive value for postoperative surgical efficacy.
Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P＞0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P＞0.05). ConclusionReasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.
Objective To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. ResultsThe average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). ConclusionCompared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.